Provider Demographics
NPI:1215205174
Name:DR. MICHAEL I. GOLDSTEIN, DC, PC
Entity Type:Organization
Organization Name:DR. MICHAEL I. GOLDSTEIN, DC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:IRA
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:845-362-6200
Mailing Address - Street 1:60 MARINER WAY
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-1653
Mailing Address - Country:US
Mailing Address - Phone:845-362-6200
Mailing Address - Fax:845-362-7351
Practice Address - Street 1:60 MARINER WAY
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-1653
Practice Address - Country:US
Practice Address - Phone:845-362-6200
Practice Address - Fax:845-362-7351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty