Provider Demographics
NPI:1891044608
Name:MICHAEL H. GOLDMAN, MD,PA
Entity type:Organization
Organization Name:MICHAEL H. GOLDMAN, MD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:2015-568-1108
Mailing Address - Street 1:600 E PALISADE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-1828
Mailing Address - Country:US
Mailing Address - Phone:201-568-1108
Mailing Address - Fax:201-568-9249
Practice Address - Street 1:600 E PALISADE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-1828
Practice Address - Country:US
Practice Address - Phone:201-568-1108
Practice Address - Fax:201-568-9249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMAO2939200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D19200Medicare UPIN