MEDICARE: DR. FAITH RENEE 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	207V00000X	Obstetrics & Gynecology Physician	236216	NY
2	208600000X	Surgery Physician	25MA08293800	NJ

General Provider Information

NPI Number	:	1861487894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FAITH RENEE GOLDMAN M.D.

Provider Business Mailing Address
First Line	:	350 ENGLE ST
Second Line	:	ENGLEWOOD HOSPITAL AND MEDICAL CENTER, BREAST SERVICES
City	:	ENGLEWOOD
State	:	NJ
Zip	:	07631-1808
Country	:	US
Telephone Number	:	201-894-3893
Fax Number	:	201-894-3764

Provider Business Practice Location Address
First Line	:	350 ENGLE ST
Second Line	:	ENGLEWOOD HOSPITAL AND MEDICAL CENTER, BREAST SERVICES
City	:	ENGLEWOOD
State	:	NJ
Zip	:	07631-1808
Country	:	US
Telephone Number	:	201-894-3893
Fax Number	:	201-894-3764

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

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	12/12/2007

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