Provider Demographics
NPI:1770684474
Name:GOLDSTEIN, MITCHELL NILES (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:NILES
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-2622
Mailing Address - Country:US
Mailing Address - Phone:516-816-7878
Mailing Address - Fax:
Practice Address - Street 1:325 MERRICK AVE STE 3
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-1556
Practice Address - Country:US
Practice Address - Phone:516-855-5880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146609207X00000X
CAG52410207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC11145Medicare UPIN