Active NPI
Gary M Goldman, PSYD
- Psychologist
- Great Neck, NY
National Provider Identifier
1376617993
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 11014
- Practice address
- 15 Bond Street
Suite 105
Great Neck, NY 11021 - Phone
- (516) 466-6823
- NPI assigned
- Nov 17, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 11014 | NY | Primary |
Addresses
Primary practice location
15 Bond Street
Suite 105
Great Neck, NY 11021
Mailing address
15 Bond Street
Suite 105
Great Neck, NY 11021
Phone (516) 466-6823
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11014 | NY | MD | Psychologist |
| 011014 | NY | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163721600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1376617993",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 BOND STREET",
"address_2": "SUITE 105",
"city": "GREAT NECK",
"state": "NY",
"postal_code": "11021",
"telephone_number": "516-466-6823"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 BOND STREET",
"address_2": "SUITE 105",
"city": "GREAT NECK",
"state": "NY",
"postal_code": "11021",
"telephone_number": "516-466-6823"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOLDMAN",
"first_name": "GARY",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NY",
"license": "11014",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Great Neck, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.