Provider Demographics
NPI:1275559973
Name:GOLDIN, EUGENE CARL (EDD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:CARL
Last Name:GOLDIN
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 LUQUER RD
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-4137
Mailing Address - Country:US
Mailing Address - Phone:516-242-3144
Mailing Address - Fax:
Practice Address - Street 1:154 LUQUER RD
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-4137
Practice Address - Country:US
Practice Address - Phone:516-242-3144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000132101YM0800X
NY000161106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist