Provider Demographics
NPI:1457666539
Name:GOLDMAN, KARA JILL
Entity Type:Individual
Prefix:DR
First Name:KARA
Middle Name:JILL
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1784 HAMBURG TPKE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-4094
Mailing Address - Country:US
Mailing Address - Phone:917-379-9811
Mailing Address - Fax:
Practice Address - Street 1:574 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-1001
Practice Address - Country:US
Practice Address - Phone:908-518-3743
Practice Address - Fax:908-673-7269
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA088223000207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3812650000OtherAMERIHEALTH
NJ0243892Medicaid
NJ3812650000OtherAMERIHEALTH