Basic Information
| Provider Information | |||||||||
| NPI: | 1609877125 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOLDMARK | ||||||||
| FirstName: | HARRY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 S. MAIN ST. | ||||||||
| Address2: | |||||||||
| City: | NEW CITY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8456347500 | ||||||||
| FaxNumber: | 8456347566 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 S. MAIN ST. | ||||||||
| Address2: | |||||||||
| City: | NEW CITY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8456347500 | ||||||||
| FaxNumber: | 8456347566 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 120598 | NY | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 00945657 | 05 | NY | MEDICAID | 0065352 | 01 | NY | GHI | OTHER | OD0444 | 01 | NY | HEALTHNET | OTHER | RS170 | 01 | NY | OXFORD | OTHER |