Provider Demographics
NPI:1992879951
Name:GOLDMAN, BARRY EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:EDWARD
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 1:66 FOREST GLEN RD
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-2611
Mailing Address - Country:US
Mailing Address - Phone:845-255-5450
Mailing Address - Fax:845-255-5854
Practice Address - Street 1:66 FOREST GLEN RD
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-2611
Practice Address - Country:US
Practice Address - Phone:845-255-5450
Practice Address - Fax:845-255-5854
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY155612-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00929144Medicaid
NYA63475Medicare UPIN
NY00929144Medicaid