Provider Demographics
NPI:1851571103
Name:GOLDSTEIN, RONALD R (BS PHARM)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:R
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:BS PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:371 HORSEBLOCK RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-1203
Mailing Address - Country:US
Mailing Address - Phone:631-698-2900
Mailing Address - Fax:631-698-8215
Practice Address - Street 1:371 HORSEBLOCK RD
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-1203
Practice Address - Country:US
Practice Address - Phone:631-698-2900
Practice Address - Fax:631-698-8215
Is Sole Proprietor?:No
Enumeration Date:2007-11-04
Last Update Date:2007-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027457183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY18Medicaid