Healthcare Provider Details

I. General information

NPI: 1245261551
Provider Name (Legal Business Name): DAVID GOLDWAG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 ROBBINS STREET
WATERBURY CT
06708
US

IV. Provider business mailing address

307 S. EVERGREEN AVE #101
WOODBURY NJ
08096
US

V. Phone/Fax

Practice location:
  • Phone: 203-573-6000
  • Fax:
Mailing address:
  • Phone: 856-848-3817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number234179-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number42440
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: