Provider Demographics
NPI:1215018353
Name:GOLDSTEIN, PENNY RUTH (DC)
Entity Type:Individual
Prefix:DR
First Name:PENNY
Middle Name:RUTH
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3932 HYLAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-3428
Mailing Address - Country:US
Mailing Address - Phone:718-317-5300
Mailing Address - Fax:718-948-2917
Practice Address - Street 1:3932 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-3428
Practice Address - Country:US
Practice Address - Phone:718-317-5300
Practice Address - Fax:718-948-2917
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX002087-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
X12511Medicare ID - Type Unspecified