MEDICARE: DR. BORIS GOLDMAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	034822	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104821560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BORIS GOLDMAN M.D.

Provider Business Mailing Address
First Line	:	32 IMPERIAL AVE
Second Line	:	2ND FLOOR
City	:	WESTPORT
State	:	CT
Zip	:	06880-4328
Country	:	US
Telephone Number	:	203-222-3700
Fax Number	:	203-222-3703

Provider Business Practice Location Address
First Line	:	2 WINDING BROOK RD
Second Line	:
City	:	NEWTOWN
State	:	CT
Zip	:	06470-2534
Country	:	US
Telephone Number	:	203-426-7018
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	07/08/2007

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