Provider Demographics
NPI:1912094871
Name:GOLDMAN, DONNA MARIE (PT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24214 PINE ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLASTON
Mailing Address - State:NY
Mailing Address - Zip Code:11363-1833
Mailing Address - Country:US
Mailing Address - Phone:917-680-7363
Mailing Address - Fax:718-229-2946
Practice Address - Street 1:24214 PINE ST
Practice Address - Street 2:
Practice Address - City:DOUGLASTON
Practice Address - State:NY
Practice Address - Zip Code:11363-1833
Practice Address - Country:US
Practice Address - Phone:917-680-7363
Practice Address - Fax:718-229-2946
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0093992251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY583958Medicare PIN