=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255500070
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STEVEN L GOLDMAN MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2008
-----------------------------------------------------
Last Update Date | 11/12/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7 HIGH ST SUITE 305
-----------------------------------------------------
City | HUNTINGTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11743-7605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-549-5864
-----------------------------------------------------
Fax | 631-549-2869
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7 HIGH ST SUITE 305
-----------------------------------------------------
City | HUNTINGTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11743-7605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-549-5864
-----------------------------------------------------
Fax | 631-549-2869
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. STEVEN L GOLDMAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 631-549-5864
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------