Provider Demographics
NPI:1932109493
Name:GOLDSCHMIDT, MARC ELIOT (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:ELIOT
Last Name:GOLDSCHMIDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:STONY BROOK UNIVERSITY HHS CENTER T16-030
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-6136
Practice Address - Country:US
Practice Address - Phone:631-444-3278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07592500207RC0000X
NY225549-01207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0022853Medicaid
NJ072159Medicare ID - Type Unspecified
NJ0022853Medicaid