Healthcare Provider Details

I. General information

NPI: 1003201443
Provider Name (Legal Business Name): JEFFREY GOLTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 CENTRAL AVE STE 207
WOODMERE NY
11598-1205
US

IV. Provider business mailing address

999 CENTRAL AVE STE 207
WOODMERE NY
11598-1205
US

V. Phone/Fax

Practice location:
  • Phone: 516-210-6701
  • Fax: 866-529-2906
Mailing address:
  • Phone: 516-210-6701
  • Fax: 866-529-2906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number292295
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: