Provider Demographics
NPI:1063585735
Name:GOLDMAN, BARRY JONATHAN (MSPT)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:JONATHAN
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-3056
Mailing Address - Country:US
Mailing Address - Phone:347-886-4062
Mailing Address - Fax:
Practice Address - Street 1:7001 AMBOY RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10307-1444
Practice Address - Country:US
Practice Address - Phone:718-227-4400
Practice Address - Fax:718-227-4401
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025483-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ12M71Medicare PIN