MEDICARE: DAVIDA GOLTZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	MD471556	PA
2	2084N0400X	Neurology Physician	27706	MS
3	2084N0400X	Neurology Physician	E-13234	AR
4	2084N0400X	Neurology Physician	61819	TN

General Provider Information

NPI Number	:	1053725044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVIDA GOLTZ M.D.

Provider Business Mailing Address
First Line	:	28 GLENWOOD RD
Second Line	:
City	:	PLAINVIEW
State	:	NY
Zip	:	11803-1125
Country	:	US
Telephone Number	:	201-527-0885
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 PELHAM PKWY S
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-1138
Country	:	US
Telephone Number	:	718-918-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2014
Last Update Date	:	06/11/2026

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