Provider Demographics
NPI:1710054002
Name:GOLDSTEIN, GLENN ALLAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:ALLAN
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:157 E 57TH ST APT 5F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2113
Mailing Address - Country:US
Mailing Address - Phone:212-371-0500
Mailing Address - Fax:212-371-0550
Practice Address - Street 1:110 EAST 59TH STREET
Practice Address - Street 2:SUITE 10A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022
Practice Address - Country:US
Practice Address - Phone:212-371-0500
Practice Address - Fax:212-371-0550
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146182207R00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
31D181Medicare ID - Type Unspecified
C08203Medicare UPIN