Provider Demographics
NPI:1942386826
Name:GOLDWASSER, STUART W (PA)
Entity Type:Individual
Prefix:MR
First Name:STUART
Middle Name:W
Last Name:GOLDWASSER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:1153 58TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-4526
Mailing Address - Country:US
Mailing Address - Phone:718-853-7161
Mailing Address - Fax:718-484-0236
Practice Address - Street 1:4802 10TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2916
Practice Address - Country:US
Practice Address - Phone:718-283-8793
Practice Address - Fax:718-283-8713
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY007489363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant