Provider Demographics
NPI:1861497315
Name:GOLDSTEIN, CARL (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:
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 1:77 BRANT AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-1560
Mailing Address - Country:US
Mailing Address - Phone:732-382-0091
Mailing Address - Fax:732-382-8570
Practice Address - Street 1:215 NORTH AVE W
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-1428
Practice Address - Country:US
Practice Address - Phone:908-232-4321
Practice Address - Fax:908-232-7788
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA38261207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2000105Medicaid
NJ2000105Medicaid
NJ072606Medicare PIN