Provider Demographics
NPI:1487729976
Name:GOLDWEITZ, JONATHAN CARLTON (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:CARLTON
Last Name:GOLDWEITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 WASHINGTON BLVD
Mailing Address - Street 2:EHE INTERNATIONAL-5TH FLOOR
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06901-3722
Mailing Address - Country:US
Mailing Address - Phone:203-348-7500
Mailing Address - Fax:203-964-9029
Practice Address - Street 1:750 WASHINGTON BLVD
Practice Address - Street 2:EHE INTERNATIONAL-5TH FLOOR
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06901-3722
Practice Address - Country:US
Practice Address - Phone:203-348-7500
Practice Address - Fax:203-964-9029
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT021382207R00000X
NY125075-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTB39343Medicare UPIN