Provider Demographics
NPI:1912183799
Name:DAVID GOLDHABER DPM, PC
Entity Type:Organization
Organization Name:DAVID GOLDHABER DPM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDHABER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-706-6341
Mailing Address - Street 1:4315 46TH ST
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-2060
Mailing Address - Country:US
Mailing Address - Phone:718-706-6341
Mailing Address - Fax:718-729-2303
Practice Address - Street 1:4315 46TH ST
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-2060
Practice Address - Country:US
Practice Address - Phone:718-706-6341
Practice Address - Fax:718-729-2303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN03090332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1281100001Medicare NSC
NYT31899Medicare UPIN