Healthcare Provider Details

I. General information

NPI: 1013021674
Provider Name (Legal Business Name): HOWARD JAY GOLDSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROSPECT AVE STE 315
HACKENSACK NJ
07601-1997
US

IV. Provider business mailing address

20 PROSPECT AVE STE 315
HACKENSACK NJ
07601-1997
US

V. Phone/Fax

Practice location:
  • Phone: 862-204-3461
  • Fax:
Mailing address:
  • Phone: 862-204-3461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA03315200
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: