Provider Demographics
NPI:1871522359
Name:GOLDBAUM, ANDREW M (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:M
Last Name:GOLDBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 PARK AVE
Mailing Address - Street 2:SUITE 1-B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7016
Mailing Address - Country:US
Mailing Address - Phone:212-288-2800
Mailing Address - Fax:
Practice Address - Street 1:605 PARK AVE
Practice Address - Street 2:SUITE 1-B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-7016
Practice Address - Country:US
Practice Address - Phone:212-288-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06705900207W00000X
NY184997207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E49213Medicare UPIN