Provider Demographics
NPI:1043247828
Name:GOLDSTEIN, PERRY CHET (RN, BSN,CMSRN)
Entity Type:Individual
Prefix:MR
First Name:PERRY
Middle Name:CHET
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:RN, BSN,CMSRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:647 US ROUTE 1
Mailing Address - Street 2:#14149
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-1689
Mailing Address - Country:US
Mailing Address - Phone:207-272-4787
Mailing Address - Fax:207-221-1273
Practice Address - Street 1:647 US ROUTE 1
Practice Address - Street 2:#14149
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1689
Practice Address - Country:US
Practice Address - Phone:207-272-4787
Practice Address - Fax:207-221-1273
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN 52296163WM0705X, 163WC0400X, 163WH0200X, 163WG0600X, 163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice