Healthcare Provider Details

I. General information

NPI: 1336131432
Provider Name (Legal Business Name): ERIC DAVID GOLDSMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 01/07/2009
Certification Date:
Deactivation Date: 03/23/2006
Reactivation Date: 04/10/2006

III. Provider practice location address

420 MADISON AVE SUITE 801
NEW YORK NY
10017-1107
US

IV. Provider business mailing address

420 MADISON AVE SUITE 801
NEW YORK NY
10017-1107
US

V. Phone/Fax

Practice location:
  • Phone: 212-486-2754
  • Fax: 212-486-2758
Mailing address:
  • Phone: 212-486-2754
  • Fax: 212-486-2758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number176973
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number176973
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: