Provider Demographics
NPI:1851478648
Name:GOLDSTEIN, LAWRENCE WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:WAYNE
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 1:200 S BROADWAY
Mailing Address - Street 2:SUITE 106
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-4500
Mailing Address - Country:US
Mailing Address - Phone:914-366-0633
Mailing Address - Fax:914-232-3366
Practice Address - Street 1:200 S BROADWAY
Practice Address - Street 2:106
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-4500
Practice Address - Country:US
Practice Address - Phone:914-366-0633
Practice Address - Fax:914-366-0641
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188101207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01415690Medicaid
F27942Medicare UPIN
44K621ANN71Medicare PIN