MEDICARE: DR. GARY H GOLDMAN MD

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	207V00000X	Obstetrics & Gynecology Physician	177375	NY

General Provider Information

NPI Number	:	1790896785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY H GOLDMAN MD

Provider Business Mailing Address
First Line	:	1735 YORK AVE STE A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10128-6855
Country	:	US
Telephone Number	:	212-535-6100
Fax Number	:	212-535-3956

Provider Business Practice Location Address
First Line	:	1735 YORK AVE STE A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10128-6855
Country	:	US
Telephone Number	:	212-535-6100
Fax Number	:	212-535-3956

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	11/18/2019

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