Provider Demographics
NPI:1316002645
Name:GOLDSTEIN, SAMMY (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMMY
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 WOODGLEN DR
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-4227
Mailing Address - Country:US
Mailing Address - Phone:845-634-7231
Mailing Address - Fax:201-866-3448
Practice Address - Street 1:707 SUMMIT AVE STE 2
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-3463
Practice Address - Country:US
Practice Address - Phone:201-863-0816
Practice Address - Fax:201-866-3448
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ148521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3628906Medicaid