Provider Demographics
NPI:1245455732
Name:GOLDSTEIN, MARTIN (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 W 44TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-5902
Mailing Address - Country:US
Mailing Address - Phone:212-575-1686
Mailing Address - Fax:212-575-1747
Practice Address - Street 1:19 W 44TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-5902
Practice Address - Country:US
Practice Address - Phone:212-575-1686
Practice Address - Fax:212-575-1747
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY03460156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician