MEDICARE: DR. THOMAS ISRAEL GOLDMAN D.P.M.

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	213E00000X	Podiatrist	005362	NY
2	213ES0131X	Foot Surgery Podiatrist	005362	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	04891	OTHER	NY	MEDICARE /GHI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5624704	OTHER	NY	AETNA ID
2	P95263	OTHER	NY	BLUE CROSS BLUE SHIELD
4	6201507	OTHER	NY	GHI
5	3C3513	OTHER	NY	HEALTHNET
6	P2176344	OTHER	NY	OXFORD

General Provider Information

NPI Number	:	1073538443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS ISRAEL GOLDMAN D.P.M.

Provider Business Mailing Address
First Line	:	450 PARK AVE
Second Line	:	SUITE #2-B
City	:	NEW YORK
State	:	NY
Zip	:	10016-7320
Country	:	US
Telephone Number	:	212-679-6776
Fax Number	:	212-679-6538

Provider Business Practice Location Address
First Line	:	450 PARK AVE
Second Line	:	SUITE #2-B
City	:	NEW YORK
State	:	NY
Zip	:	10016-7320
Country	:	US
Telephone Number	:	212-679-6776
Fax Number	:	212-679-6538

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	07/18/2008

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Directions to “ DR. THOMAS ISRAEL GOLDMAN D.P.M.” Practice Location

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