Provider Demographics
NPI:1659441863
Name:GOLDSTEIN, PAUL BENNET (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:BENNET
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:BOUND BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08805-2018
Mailing Address - Country:US
Mailing Address - Phone:732-271-0400
Mailing Address - Fax:732-271-0275
Practice Address - Street 1:225 HAMILTON ST
Practice Address - Street 2:
Practice Address - City:BOUND BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08805-2018
Practice Address - Country:US
Practice Address - Phone:732-271-0400
Practice Address - Fax:732-271-0275
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMCO2653111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ178468Medicare PIN