Active NPI
Warren C Goldblum, DO
- Family Medicine Physician
- Eastchester, NY
National Provider Identifier
1376700468
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 091340-1
- Practice address
- 41 Waterside Close
Eastchester, NY 10709-5654 - Phone
- (914) 337-3336
- Fax
- (914) 337-3336
- NPI assigned
- May 18, 2008
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 091340-1 | NY | Primary |
Addresses
Primary practice location
41 Waterside Close
Eastchester, NY 10709-5654
Mailing address
41 Waterside Close
Eastchester, NY 10709-5654
Phone (914) 337-3336
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00241149 | Medicaid | NY |
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
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 091340 | NY | MD | Clinical Social Worker |
| 091340-1 | NY | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1211068800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211068800000",
"number": "1376700468",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "41 WATERSIDE CLOSE",
"city": "EASTCHESTER",
"state": "NY",
"postal_code": "107095654",
"telephone_number": "914-337-3336",
"fax_number": "914-337-3336"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "41 WATERSIDE CLOSE",
"city": "EASTCHESTER",
"state": "NY",
"postal_code": "107095654",
"telephone_number": "914-337-3336",
"fax_number": "914-337-3336"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOLDBLUM",
"first_name": "WARREN",
"middle_name": "C",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-05-18",
"last_updated": "2008-05-18",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NY",
"license": "091340-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00241149",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Eastchester, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.