Provider Demographics
NPI:1073538443
Name:GOLDMAN, THOMAS ISRAEL (DPM)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ISRAEL
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:450 PARK AVE
Mailing Address - Street 2:SUITE #2-B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-7320
Mailing Address - Country:US
Mailing Address - Phone:212-679-6776
Mailing Address - Fax:212-679-6538
Practice Address - Street 1:450 PARK AVE
Practice Address - Street 2:SUITE #2-B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-7320
Practice Address - Country:US
Practice Address - Phone:212-679-6776
Practice Address - Fax:212-679-6538
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005362213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5624704OtherAETNA ID
NYP95263OtherBLUE CROSS BLUE SHIELD
NY04891OtherMEDICARE /GHI
NY6201507OtherGHI
NY3C3513OtherHEALTHNET
NYP2176344OtherOXFORD
NYP2176344OtherOXFORD
NY4339190001Medicare NSC
NY04891OtherMEDICARE /GHI