Provider Demographics
NPI:1942209028
Name:GOLDSTEIN, MARCY A (MD)
Entity Type:Individual
Prefix:
First Name:MARCY
Middle Name:A
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W RIDGEWOOD AVE
Mailing Address - Street 2:SUITE # 305
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-2359
Mailing Address - Country:US
Mailing Address - Phone:201-445-8786
Mailing Address - Fax:201-445-8811
Practice Address - Street 1:1 W RIDGEWOOD AVE
Practice Address - Street 2:SUITE # 305
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2359
Practice Address - Country:US
Practice Address - Phone:201-445-8786
Practice Address - Fax:201-445-8811
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05994500174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF81225Medicare UPIN
NJ048253Medicare ID - Type Unspecified