Provider Demographics
NPI:1952463200
Name:GOLDSTEIN, MARK (DC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 THE PROMENADE
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-2109
Mailing Address - Country:US
Mailing Address - Phone:917-533-3197
Mailing Address - Fax:212-768-1223
Practice Address - Street 1:512 FASHION AVE
Practice Address - Street 2:1404A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-4603
Practice Address - Country:US
Practice Address - Phone:212-768-7979
Practice Address - Fax:212-768-1223
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009637-1111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician