Provider Demographics
NPI:1598821688
Name:GOLDSTEIN, ELLEN E (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:E
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PARK AVE S
Mailing Address - Street 2:SUITE 1414
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-1503
Mailing Address - Country:US
Mailing Address - Phone:212-255-5730
Mailing Address - Fax:212-533-8232
Practice Address - Street 1:200 PARK AVE S
Practice Address - Street 2:SUITE 1414
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-1503
Practice Address - Country:US
Practice Address - Phone:212-255-5730
Practice Address - Fax:212-533-8232
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY363771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice