Provider Demographics
NPI:1558353102
Name:GOLDIN, MICHAEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:GOLDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 JEFFERSON RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-3790
Mailing Address - Country:US
Mailing Address - Phone:973-386-0072
Mailing Address - Fax:973-956-9549
Practice Address - Street 1:601 JEFFERSON RD
Practice Address - Street 2:SUITE 107
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-3790
Practice Address - Country:US
Practice Address - Phone:973-386-0072
Practice Address - Fax:973-956-9549
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2010-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA039616002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
477582Medicare ID - Type Unspecified
E71925Medicare UPIN