Provider Demographics
NPI:1619966850
Name:GOLDSTEIN, DEBRA R (MD)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:R
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 MAY ST
Mailing Address - Street 2:STE E
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-3266
Mailing Address - Country:US
Mailing Address - Phone:732-661-2020
Mailing Address - Fax:732-661-2022
Practice Address - Street 1:225 MAY ST
Practice Address - Street 2:STE E
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3266
Practice Address - Country:US
Practice Address - Phone:732-661-2020
Practice Address - Fax:732-661-2022
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05795600207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6098703Medicaid
E94805Medicare UPIN
727304Medicare ID - Type Unspecified