Provider Demographics
NPI:1578561452
Name:GOLDSTEIN, MERYL STACEY (MPT)
Entity Type:Individual
Prefix:MRS
First Name:MERYL
Middle Name:STACEY
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MR
Other - First Name:MERYL
Other - Middle Name:STACEY
Other - Last Name:GELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:420 BAINBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-1568
Mailing Address - Country:US
Mailing Address - Phone:215-629-3837
Mailing Address - Fax:215-629-5531
Practice Address - Street 1:1888 ROUTE 70 E
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2178
Practice Address - Country:US
Practice Address - Phone:856-424-7524
Practice Address - Fax:856-424-7599
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01068200225100000X
PAPT015033225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12267951OtherMULTIPLAN
2009310000OtherBC/BS HMO
1316251OtherBC/BS PPO
NJ085972S2KMedicare ID - Type UnspecifiedMEDICARE
PA083397SAVMedicare ID - Type UnspecifiedMEDICARE