Healthcare Provider Details

I. General information

NPI: 1053739565
Provider Name (Legal Business Name): ARIELLA GOLDMAN M.D., MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1176 5TH AVE BOX 1170
NEW YORK NY
10029-6503
US

IV. Provider business mailing address

1176 5TH AVE BOX 1170
NEW YORK NY
10029-6503
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-8578
  • Fax: 212-241-3833
Mailing address:
  • Phone: 212-241-8578
  • Fax: 212-241-3833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number292425
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: