Provider Demographics
NPI:1407136351
Name:GOLDSTEIN, JEFFREY PETER (PT)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:PETER
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 REDFIELD RD
Mailing Address - Street 2:
Mailing Address - City:ISLAND PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11558-1018
Mailing Address - Country:US
Mailing Address - Phone:516-897-5399
Mailing Address - Fax:516-897-5399
Practice Address - Street 1:33 REDFIELD RD
Practice Address - Street 2:
Practice Address - City:ISLAND PARK
Practice Address - State:NY
Practice Address - Zip Code:11558-1018
Practice Address - Country:US
Practice Address - Phone:516-897-5399
Practice Address - Fax:516-897-5399
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9543225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist