Provider Demographics
NPI:1093871733
Name:GOLDSTEIN, JUDITH ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ANN
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:245 EAST 25 STREET
Mailing Address - Street 2:APT 5E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-3044
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 N VILLAGE AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-2341
Practice Address - Country:US
Practice Address - Phone:516-536-8151
Practice Address - Fax:516-515-5368
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY142134207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01043576Medicaid
B79482Medicare UPIN
NY79A051Medicare ID - Type Unspecified