=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073513735
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GEORGE M GOLDMARK M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2005
-----------------------------------------------------
Last Update Date | 06/18/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 350 S MAIN ST
-----------------------------------------------------
City | NEW CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10956-3002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-634-7500
-----------------------------------------------------
Fax | 845-634-7566
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 350 S MAIN ST
-----------------------------------------------------
City | NEW CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10956-3002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-634-7500
-----------------------------------------------------
Fax | 845-634-7566
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 120730
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------