Provider Demographics
NPI:1861487894
Name:GOLDMAN, FAITH RENEE (MD)
Entity Type:Individual
Prefix:DR
First Name:FAITH
Middle Name:RENEE
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:FAITH
Other - Middle Name:RENEE
Other - Last Name:HORTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:350 ENGLE ST
Mailing Address - Street 2:ENGLEWOOD HOSPITAL AND MEDICAL CENTER, BREAST SERVICES
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-1808
Mailing Address - Country:US
Mailing Address - Phone:201-894-3893
Mailing Address - Fax:201-894-3764
Practice Address - Street 1:350 ENGLE ST
Practice Address - Street 2:ENGLEWOOD HOSPITAL AND MEDICAL CENTER, BREAST SERVICES
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-1808
Practice Address - Country:US
Practice Address - Phone:201-894-3893
Practice Address - Fax:201-894-3764
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236216207V00000X
NJ25MA08293800208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI51188Medicare UPIN