Provider Demographics
NPI:1821181082
Name:GOLDSTEIN, RICHARD J (DPM)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:57 WEST 57TH STREET
Mailing Address - Street 2:STE 1201
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-2802
Mailing Address - Country:US
Mailing Address - Phone:716-456-8027
Mailing Address - Fax:212-755-3676
Practice Address - Street 1:57 WEST 57TH STREET
Practice Address - Street 2:STE 1201
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2802
Practice Address - Country:US
Practice Address - Phone:716-456-8027
Practice Address - Fax:212-755-3676
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MD00273200213ES0103X
NYN005039-1213ES0131X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU49086Medicare UPIN
NJ075904Medicare PIN