Healthcare Provider Details

I. General information

NPI: 1700937133
Provider Name (Legal Business Name): JEFFREY A GOLDMAN PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32-34 MAIN ST
STAMFORD NY
12167-1145
US

IV. Provider business mailing address

32-34 MAIN ST
STAMFORD NY
12167-1145
US

V. Phone/Fax

Practice location:
  • Phone: 607-652-2000
  • Fax: 607-652-2433
Mailing address:
  • Phone: 607-652-2000
  • Fax: 607-652-2433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4594
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: