Healthcare Provider Details

I. General information

NPI: 1902076938
Provider Name (Legal Business Name): BARRY E.GOLDMAN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 FOREST GLEN RD
NEW PALTZ NY
12561-2611
US

IV. Provider business mailing address

66 FOREST GLEN RD
NEW PALTZ NY
12561-2611
US

V. Phone/Fax

Practice location:
  • Phone: 845-255-5450
  • Fax: 845-255-5854
Mailing address:
  • Phone: 845-255-5450
  • Fax: 845-255-5854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number155612-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF334111-1
License Number StateNY

VIII. Authorized Official

Name: DR. BARRY EDWARD GOLDMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 845-255-5450