Provider Demographics
NPI:1952497968
Name:GOLDSCHLAG, DAN E (MD)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:E
Last Name:GOLDSCHLAG
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 1:1305 YORK AVE
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5663
Mailing Address - Country:US
Mailing Address - Phone:646-962-3077
Mailing Address - Fax:646-962-0305
Practice Address - Street 1:1305 YORK AVE
Practice Address - Street 2:6TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5663
Practice Address - Country:US
Practice Address - Phone:212-746-0343
Practice Address - Fax:212-746-3511
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY203116207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH70993Medicare UPIN
NY569D51Medicare ID - Type UnspecifiedMEDICARE#