Provider Demographics
NPI:1134198500
Name:GOLDSTEIN, JUDY (MD)
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:
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 1:1365 YORK AVE APT 7K
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-0432
Mailing Address - Country:US
Mailing Address - Phone:917-881-6166
Mailing Address - Fax:
Practice Address - Street 1:115 E 57TH ST STE 1450
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2109
Practice Address - Country:US
Practice Address - Phone:646-727-7373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY118388208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCO7985Medicare UPIN
CO7985Medicare UPIN