MEDICARE: THOMAS GOLDMAN

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	332BC3200X	Customized Equipment (DME)	N005362	NY

General Provider Information

NPI Number	:	1619139144
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS GOLDMAN

Provider Business Mailing Address
First Line	:	450 PARK AVE S
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-7320
Country	:	US
Telephone Number	:	212-679-6776
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 PARK AVE S
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-7320
Country	:	US
Telephone Number	:	212-679-6776
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	THOMAS ISRAEL GOLDMAN
Credential	:	DPM
Telephone Number	:	212-679-6776

Provider Enumeration Date	:	06/26/2008
Last Update Date	:	06/26/2008

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Directions to “THOMAS GOLDMAN ” Practice Location

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