Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 143673 | NY |
NPI | 1033141726 |
---|---|
Provider Name | Dr. Gregory Ira Goldman |
First Address | Cornwall, NY 12518-1410 |
Second Address | Cornwall, NY 12518-1410 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01101940 | (05) | NY |
C08790 | (02) | NY |