Provider Demographics
NPI:1043211097
Name:GOLDSTOFF, MICHAEL S (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:GOLDSTOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1201 NOTT ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308-2589
Mailing Address - Country:US
Mailing Address - Phone:518-374-3123
Mailing Address - Fax:518-374-9711
Practice Address - Street 1:1201 NOTT ST
Practice Address - Street 2:SUITE 106
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-2589
Practice Address - Country:US
Practice Address - Phone:518-374-3123
Practice Address - Fax:518-374-9711
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY176891-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000090270OtherGHI HMO
NY01462106Medicaid
000410982001OtherBLUE SHIELD
00A41OtherEMPIRE BLUE CROSS
9707635OtherGHI
10000788OtherCDPHP
110160500OtherUS DEPT OF LABOR
05223OtherMVP
33588QOtherFIDELIS MEDICARE
040426006658OtherFIDELIS
176891-1OtherTRICARE NORTH REGION
MG000A4110OtherEMPIRE BLUE CROSS
MG000A4120OtherEMPIRE BLUE CROSS
000410982002OtherBLUE SHIELD NENY
CAN1768910OtherWORKERS COMP
CAN1768910OtherNO FAULT
F72435OtherAMERICAN PROGRESSIVE TODA
176891-1OtherTRICARE NORTH REGION
10000788OtherCDPHP
050037462Medicare PIN