Healthcare Provider Details

I. General information

NPI: 1518161702
Provider Name (Legal Business Name): MARCI ANNE GOOLSBY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 E 70TH ST
NEW YORK NY
10021-4823
US

IV. Provider business mailing address

535 E 70TH ST
NEW YORK NY
10021-4823
US

V. Phone/Fax

Practice location:
  • Phone: 646-797-8232
  • Fax:
Mailing address:
  • Phone: 646-797-8232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number257420-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: