Provider Demographics
NPI:1023149663
Name:GOLDSCHMIDT, ELIE (LAC)
Entity type:Individual
Prefix:
First Name:ELIE
Middle Name:
Last Name:GOLDSCHMIDT
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 PROSPECT AVE
Mailing Address - Street 2:APT. 8C
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1820
Mailing Address - Country:US
Mailing Address - Phone:201-349-4566
Mailing Address - Fax:
Practice Address - Street 1:275 ROUTE 304
Practice Address - Street 2:
Practice Address - City:BARDONIA
Practice Address - State:NY
Practice Address - Zip Code:10954-2049
Practice Address - Country:US
Practice Address - Phone:845-623-4040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY945171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist