Provider Demographics
NPI:1972063980
Name:JENNIFER GOLDWASSER MD PLLC
Entity Type:Organization
Organization Name:JENNIFER GOLDWASSER MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:HOPE
Authorized Official - Last Name:GOLDWASSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-422-3376
Mailing Address - Street 1:210 N CENTRAL AVE STE 320
Mailing Address - Street 2:
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-1951
Mailing Address - Country:US
Mailing Address - Phone:914-422-3376
Mailing Address - Fax:
Practice Address - Street 1:210 N CENTRAL AVE STE 320
Practice Address - Street 2:
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-1951
Practice Address - Country:US
Practice Address - Phone:914-422-3376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-25
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty