Provider Demographics
NPI:1265657662
Name:BENJY GOLDSTEIN & GEORGE FREUD DDS PLLC
Entity Type:Organization
Organization Name:BENJY GOLDSTEIN & GEORGE FREUD DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:FREUD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:845-564-9300
Mailing Address - Street 1:1401 ROUTE 300
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-2990
Mailing Address - Country:US
Mailing Address - Phone:845-564-9300
Mailing Address - Fax:845-564-9307
Practice Address - Street 1:1401 ROUTE 300
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-2990
Practice Address - Country:US
Practice Address - Phone:845-564-9300
Practice Address - Fax:845-564-9307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0354641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02258491Medicaid