Provider Demographics
NPI:1073638904
Name:GOLDSTEIN, REUVEN (LIC AC)
Entity Type:Individual
Prefix:
First Name:REUVEN
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MAIN ST
Mailing Address - Street 2:SUITE 339C
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3109
Mailing Address - Country:US
Mailing Address - Phone:413-585-5773
Mailing Address - Fax:
Practice Address - Street 1:25 MAIN ST
Practice Address - Street 2:SUITE 339C
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3109
Practice Address - Country:US
Practice Address - Phone:413-585-5773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA204909171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist