MEDICARE: BARRY DAVID 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	207N00000X	Dermatology Physician	188106-1	NY

General Provider Information

NPI Number	:	1831139856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARRY DAVID GOLDMAN M.D.

Provider Business Mailing Address
First Line	:	150 BROADWAY
Second Line	:	SUITE #1110
City	:	NEW YORK
State	:	NY
Zip	:	10038-4357
Country	:	US
Telephone Number	:	212-962-1115
Fax Number	:	212-962-1246

Provider Business Practice Location Address
First Line	:	150 BROADWAY
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10038-4381
Country	:	US
Telephone Number	:	212-962-1115
Fax Number	:	212-962-1246

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	10/16/2015

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