Bernard Goldman, DMD
Individual provider Active NPI Endodontics · Valatie, NY
NPI 1740445006 · NPPES record last updated Jul 25, 2008
Key facts
- NPI
- 1740445006
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Endodontics 1223E0200X
- License
- 039676 (NY)
- Practice address
- 18 Wilderness Lane
Valatie, NY 12184 - Phone
- (518) 758-6359
- NPI assigned
- Jul 25, 2008
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150714001583 | NY | Order and Referring Only - Dentist |
1557674942 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 039676 | NY | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Columbia Dental Assoc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 039676 | NY | Yes |
Addresses
Primary practice location
18 Wilderness Lane
Valatie, NY 12184
Mailing address
18 Wilderness Lane
Valatie, NY 12184
Phone (518) 758-6359
Other providers in Valatie, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 25, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.