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General NPI Number Information
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NPI Number | 1962709378
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Entity Type | Organization
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Legal Business Name | DR. TODD GOLDMAN CHIROPRACTOR PC
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Dates
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Enumeration Date | 02/21/2011
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Last Update Date | 05/11/2011
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Provider Practice Location Address
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Address Line | 2799 ROUTE 112 STE 5
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City | MEDFORD
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State | NY
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Zip | 11763-2535
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Country | US
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Telephone | 631-447-2299
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Fax | 631-447-2297
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Provider Business Mailing Address
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Address Line | 2799 ROUTE 112 STE 5
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City | MEDFORD
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State | NY
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Zip | 11763-2535
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TODD GOLDMAN
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Credential |
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Telephone | 631-447-2299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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