Provider Demographics
NPI:1699771501
Name:GOLDMAN, NEIL S (MD)
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:S
Last Name:GOLDMAN
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 1:235 W 48TH ST
Mailing Address - Street 2:APT 26H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-1404
Mailing Address - Country:US
Mailing Address - Phone:212-929-4395
Mailing Address - Fax:212-929-6205
Practice Address - Street 1:235 W 48TH ST
Practice Address - Street 2:APT 26H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-1404
Practice Address - Country:US
Practice Address - Phone:212-929-4395
Practice Address - Fax:212-929-6205
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1330342084P0800X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00270993Medicaid
NYB13499Medicare UPIN
NY34532Medicare ID - Type Unspecified