Healthcare Provider Details

I. General information

NPI: 1497117477
Provider Name (Legal Business Name): TSIPORA M HUISMAN-GOLDSTEIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 04/08/2022
Certification Date: 04/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WOODS RD FL ACP3
VALHALLA NY
10595-1530
US

IV. Provider business mailing address

PO BOX 1118
NEW YORK NY
10029-0311
US

V. Phone/Fax

Practice location:
  • Phone: 914-493-8916
  • Fax:
Mailing address:
  • Phone: 212-241-8170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RT0003X
TaxonomyTransplant Hepatology Physician
License Number297929
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: