Provider Demographics
NPI:1942369970
Name:GOLDSTEIN, SHERRI E (OD)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:E
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SHERRI
Other - Middle Name:E
Other - Last Name:LUBEROFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:65 MARIE CRES
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-5226
Mailing Address - Country:US
Mailing Address - Phone:631-543-0385
Mailing Address - Fax:
Practice Address - Street 1:65 MARIE CRES
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-5226
Practice Address - Country:US
Practice Address - Phone:631-543-0385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT5777152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY122069Medicare UPIN