Provider Demographics
NPI:1902888001
Name:GOLDWASSER, JENNIFER HOPE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:HOPE
Last Name:GOLDWASSER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:210 N CENTRAL AVE STE 320
Mailing Address - Street 2:
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-1951
Mailing Address - Country:US
Mailing Address - Phone:914-422-3376
Mailing Address - Fax:914-409-9034
Practice Address - Street 1:210 N CENTRAL AVE STE 320
Practice Address - Street 2:
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-1951
Practice Address - Country:US
Practice Address - Phone:914-422-3376
Practice Address - Fax:914-409-9034
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184329207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01477581Medicaid
NY57H021Medicare PIN