Provider Demographics
NPI:1912019266
Name:RICHARD J GOLDSTEIN DPM PC
Entity Type:Organization
Organization Name:RICHARD J GOLDSTEIN DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:212-755-8858
Mailing Address - Street 1:57 W 57TH STREET
Mailing Address - Street 2:SUITE 1106
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019
Mailing Address - Country:US
Mailing Address - Phone:212-755-8858
Mailing Address - Fax:212-755-3676
Practice Address - Street 1:57 W 57TH STREET
Practice Address - Street 2:SUITE 1106
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:212-755-8858
Practice Address - Fax:212-755-3676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0050391213E00000X
NJ25MD00273200213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U49086Medicare UPIN
P62911Medicare ID - Type Unspecified