Healthcare Provider Details

I. General information

NPI: 1477814119
Provider Name (Legal Business Name): BERNARD GOLDWASSER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PELHAM PKWY S
BRONX NY
10461-1197
US

IV. Provider business mailing address

1346 SUSSEX RD
TEANECK NJ
07666-2809
US

V. Phone/Fax

Practice location:
  • Phone: 718-918-4595
  • Fax:
Mailing address:
  • Phone: 917-593-0605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number292087
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: