Paul Russell Goldman, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

010820 Issued in NY

Practice address

19 Mansfield Dr
Massapequa Park, NY 11762-4033

Phone

(516) 566-1398

Fax

(516) 799-4542

NPI assigned

Mar 11, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mr. Paul Goldman Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1173571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1669504130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 MANSFIELD DR",
            "city": "MASSAPEQUA PARK",
            "state": "NY",
            "postal_code": "117624033",
            "telephone_number": "516-566-1398",
            "fax_number": "516-799-4542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 MANSFIELD DR",
            "city": "MASSAPEQUA PARK",
            "state": "NY",
            "postal_code": "117624033",
            "telephone_number": "516-566-1398",
            "fax_number": "516-799-4542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLDMAN",
        "first_name": "PAUL",
        "middle_name": "RUSSELL",
        "name_prefix": "Mr.",
        "credential": "P.T.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-11",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "010820",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02046179",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PAUL",
            "last_name": "GOLDMAN",
            "prefix": "MR.",
            "credential": ".P.T.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Corinne A Giuliani, LCSW
• Jessica Giuntini, RN
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• Michele Gogliucci, LCSW
• Ann S Goldberg, LCSW
• Adam Gottlieb
• Adam Goudreau, B.A., M.A.
• Jessica Graiser
• Christine V. Green
• Angela M. Greenhalgh, LCSW

• Physical Therapist in Massapequa Park, NY
• Providers in Massapequa Park, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.