Provider Demographics
NPI:1942409487
Name:GOLDSTEIN, BARBARA (CO, CFOM)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:CO, CFOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10316
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85064-0316
Mailing Address - Country:US
Mailing Address - Phone:602-234-9568
Mailing Address - Fax:602-957-2562
Practice Address - Street 1:5350 N 16 ST
Practice Address - Street 2:101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-3213
Practice Address - Country:US
Practice Address - Phone:602-234-9568
Practice Address - Fax:602-957-2562
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-14
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1117200001Medicare NSC