Provider Demographics
NPI:1164579181
Name:GOLDSTEIN, LEE J (MD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:J
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BRIANNA LN
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:CT
Mailing Address - Zip Code:06612-1660
Mailing Address - Country:US
Mailing Address - Phone:203-210-6333
Mailing Address - Fax:
Practice Address - Street 1:495 HAWLEY LN
Practice Address - Street 2:SUITE 2A
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-1514
Practice Address - Country:US
Practice Address - Phone:203-210-6333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT527312086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400124061Medicare PIN