Healthcare Provider Details

I. General information

NPI: 1912052515
Provider Name (Legal Business Name): GOLDMAN & LEVINE ENDODONTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 12/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 WESTWOOD AVE
STATEN ISLAND NY
10314-5414
US

IV. Provider business mailing address

165 WESTWOOD AVE
STATEN ISLAND NY
10314-5414
US

V. Phone/Fax

Practice location:
  • Phone: 718-761-1200
  • Fax: 718-494-3883
Mailing address:
  • Phone: 718-761-1200
  • Fax: 718-494-3883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number039676
License Number StateNY

VIII. Authorized Official

Name: DR. BERNARD GOLDMAN,
Title or Position: PARTNER
Credential: DMD
Phone: 718-761-1200