GARY MICHAEL GOLDETSKY
NPI 1124129382
Psychologist - Rehabilitation in Minneapolis, MN

Q: What is Gary Goldetsky's NPI number?

The NPI number for Gary Goldetsky is 1124129382. It was assigned to this individual provider in the NPPES registry on September 26, 2006.

Q: What is Gary Goldetsky's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Rehabilitation, with taxonomy code 103TR0400X.

Q: When was this NPI record last updated?

The NPPES record for Gary Goldetsky was last updated on August 14, 2007. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since September 26, 2006PECOS Enrolled

515 DELAWARE ST SE, TMD CLINIC, MINNEAPOLIS, MN 55455(612) 626-6529 Get Directions Write a Review

NPPES record last updated: August 14, 2007. Verified against the NPPES registry weekly; last sync: July 26, 2026.

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About Gary Michael Goldetsky NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GARY MICHAEL GOLDETSKY (NPI 1124129382) is an individual rehabilitation provider in Minneapolis, Minnesota, licensed in Minnesota (LPO 508) and active in the NPI registry since September 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1124129382

Entity TypeIndividualMale

Primary Taxonomy103TR0400X

Provider Legal NameGARY MICHAEL GOLDETSKY

Location Address515 DELAWARE ST SE, TMD CLINICMinneapolis, MN 55455-0357

Mailing Address515 Delaware St Se, Tmd ClinicMinneapolis, MN 55455-0357

Phone(612) 626-6529

Sole ProprietorNo

Enumeration DateSeptember 26, 2006

Last NPPES UpdateAugust 14, 2007

✔ NPI 1124129382 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · RehabilitationBehavioral Health & Social Service Providers

Taxonomy Code103TR0400X

License✔ Licensed in MN · LPO 508

Definition

A psychologist who specializes in the study and application of psychological principles on behalf of persons who have disability due to injury or illness. Rehabilitation psychologists, often within teams, assess and treat cognitive, emotional, and functional difficulties, and help people to overcome barriers to participation in life activities. Rehabilitation psychologists are involved in practice, research, and advocacy, with the broad goal of fostering independence and opportunity for people with disabilities.

515 DELAWARE ST SE, Minneapolis, MN 55455

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Gary Michael Goldetsky is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.