Robert Jay Goldman, D.D.S.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

026951 Issued in NY

Practice address

6 Medical Dr
Port Jefferson Station, NY 11776-1594

Phone

(631) 928-2655

Fax

(631) 476-4635

NPI assigned

Dec 15, 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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Patrick J. Sabo, D.M.D. & Mark a. Rienecker, D.D.S., P.C.

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Port Jefferson Station, NY
  • NPI 1639231665
  NPD (past)

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

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1427110428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 MEDICAL DR",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117761594",
            "telephone_number": "631-928-2655",
            "fax_number": "631-476-4635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 MEDICAL DR",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117761594",
            "telephone_number": "631-928-2655",
            "fax_number": "631-476-4635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLDMAN",
        "first_name": "ROBERT",
        "middle_name": "JAY",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NY",
            "license": "026951",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00654802",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Suzanne Giuliani Gimpel, MD
• Samantha Theresa Glaser, BCBA, LBA
• Nataliya Glazkova, RN
• Rachel Gabrielle Gmelin
• Theodore Goldberg, M.D.
• Victor James Goldman, LCSW
• Corey Golino, PHARM D
• Mehran Golpariani, MD
• Andrea Gomez Pereira, PHYSICIAN ASSISTANT
• Kayla Elizabeth Goncalves

• Orthodontics and Dentofacial Orthopedics Dentistry in Port Jefferson Station, NY
• Providers in Port Jefferson Station, NY by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in New York

• 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.

Verify at the official NPI Registry.