Gary Michael Goldetsky

Primary specialty

Rehabilitation PsychologistTaxonomy code 103TR0400X

License

LPO 508 Issued in MN

Practice address

515 Delaware St SE
TMD Clinic
Minneapolis, MN 55455-0357

Phone

(612) 626-6529

NPI assigned

Sep 26, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Access Healthcare Services, LLC

  • Mental Health Counselor
  • Minneapolis, MN
  • NPI 1134676273
  NPD (past)
• Minnesota Head and Neck Pain Clinic, PA

  • Specialist
  • St Paul, MN
  • NPI 1104850155
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1187049600000",
    "number": "1124129382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 DELAWARE ST SE",
            "address_2": "TMD CLINIC",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554550357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 DELAWARE ST SE",
            "address_2": "TMD CLINIC",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554550357",
            "telephone_number": "612-626-6529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLDETSKY",
        "first_name": "GARY",
        "middle_name": "MICHAEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-26",
        "last_updated": "2007-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TR0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Rehabilitation",
            "state": "MN",
            "license": "LPO 508",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard Elliot Golden, M.D.
• Shahyra Golden
• Valerie Golden, PHD
• Irvin Farrel Goldenberg, MD
• Goldenheart Investment
• Michael Joseph Goldfarb, LICSW
• Noah Israel Goldfarb, M.D.
• Samuel B Goldfarb, M.D.
• Julie Goldfine, DNP
• Aaron M Goldish, D. O.

• Rehabilitation Psychologist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Rehabilitation Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.