Provider Demographics
NPI:1114002086
Name:RICHARD J. GOLDSTEIN DPM PC
Entity Type:Organization
Organization Name:RICHARD J. GOLDSTEIN DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST/SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:212-755-8858
Mailing Address - Street 1:57 W 57TH ST
Mailing Address - Street 2:SUITE 1106
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-2802
Mailing Address - Country:US
Mailing Address - Phone:212-755-8858
Mailing Address - Fax:212-755-3676
Practice Address - Street 1:57 W 57TH ST
Practice Address - Street 2:SUITE 1106
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2802
Practice Address - Country:US
Practice Address - Phone:212-755-8858
Practice Address - Fax:212-755-3676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNOO5039-1213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU49086Medicare UPIN
NYP62911Medicare ID - Type Unspecified