Provider Demographics
NPI:1215950845
Name:GOLDMAN, DAVID VICTOR (MSPT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:VICTOR
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 NORDHOFF PL FL 2
Mailing Address - Street 2:THEE GYM
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4811
Mailing Address - Country:US
Mailing Address - Phone:201-567-9399
Mailing Address - Fax:201-567-9394
Practice Address - Street 1:20 NORDHOFF PL FL 2
Practice Address - Street 2:THE GYM
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4811
Practice Address - Country:US
Practice Address - Phone:201-567-9399
Practice Address - Fax:201-567-9394
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020989225100000X
NJ40QA01155800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2300837OtherUNITED HEALTHCARE -OUT OF NETWORK
NJ6455113OtherAETNA HMO -OON
7742471OtherAETNA -OUT OF NETWORK
P4194238OtherOXFORD -OUT OF NETWORK
P4194238OtherOXFORD -OUT OF NETWORK
NJ521895-YG7HMedicare PIN