Provider Demographics
NPI:1275780090
Name:GOLDSTEIN, MITCHELL IRA (RPH)
Entity Type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:IRA
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 E 161ST ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-2207
Mailing Address - Country:US
Mailing Address - Phone:718-665-1163
Mailing Address - Fax:
Practice Address - Street 1:70 E 161ST ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-2207
Practice Address - Country:US
Practice Address - Phone:718-665-1163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304841835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY30481OtherNYS PHARMACIST LICENSE NUMBER