Provider Demographics
NPI:1053414854
Name:GOLDWEIT, RICHARD S (MD, FACC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:S
Last Name:GOLDWEIT
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 N DEAN ST
Mailing Address - Street 2:SUIITE 100
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2533
Mailing Address - Country:US
Mailing Address - Phone:201-816-2508
Mailing Address - Fax:
Practice Address - Street 1:177 N DEAN ST
Practice Address - Street 2:SUIITE 100
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2533
Practice Address - Country:US
Practice Address - Phone:201-816-2508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA51382207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5708501Medicaid
NJA63501Medicare UPIN
NJ5708501Medicaid