Provider Demographics
NPI:1841258233
Name:GOLDMAN, STUART JACK (MD)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:JACK
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5401 HARDING HWY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-2243
Mailing Address - Country:US
Mailing Address - Phone:609-625-8585
Mailing Address - Fax:609-625-3415
Practice Address - Street 1:5401 HARDING HWY
Practice Address - Street 2:SUITE 6
Practice Address - City:MAYS LANDING
Practice Address - State:NJ
Practice Address - Zip Code:08330-2243
Practice Address - Country:US
Practice Address - Phone:609-625-8585
Practice Address - Fax:609-625-3415
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA53066208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0748005Medicaid