MEDICARE: DR. ISRAEL DAVID GOLDMAN 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	207RX0202X	Medical Oncology Physician	202798-1	NY

General Provider Information

NPI Number	:	1780730564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ISRAEL DAVID GOLDMAN M.D.

Provider Business Mailing Address
First Line	:	1300 MORRIS PARK AVE
Second Line	:	CANCER CENTER, CHANIN TWO
City	:	BRONX
State	:	NY
Zip	:	10461-1900
Country	:	US
Telephone Number	:	718-430-2302
Fax Number	:	718-430-8550

Provider Business Practice Location Address
First Line	:	1300 MORRIS PARK AVE
Second Line	:	CANCER CENTER, CHANIN TWO
City	:	BRONX
State	:	NY
Zip	:	10461-1900
Country	:	US
Telephone Number	:	718-430-2302
Fax Number	:	718-430-8550

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

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	07/08/2007

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