Provider Demographics
NPI:1689059222
Name:GOLDSTEP AMBULATORY SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:GOLDSTEP AMBULATORY SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-253-1582
Mailing Address - Street 1:3007 FARRAGUT RD FL 5
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-1537
Mailing Address - Country:US
Mailing Address - Phone:718-253-1582
Mailing Address - Fax:718-434-0722
Practice Address - Street 1:3007 FARRAGUT RD FL 5
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-1537
Practice Address - Country:US
Practice Address - Phone:718-253-1582
Practice Address - Fax:718-434-0722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-24
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207L00000X
NY7001800R261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04275325Medicaid
NYA300131282Medicare UPIN