Provider Demographics
NPI:1396973442
Name:GOLDSTEIN, MARTIN B (DO)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:B
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 42ND STREET
Mailing Address - Street 2:
Mailing Address - City:AVALON
Mailing Address - State:NJ
Mailing Address - Zip Code:08202
Mailing Address - Country:US
Mailing Address - Phone:609-967-5213
Mailing Address - Fax:609-967-0870
Practice Address - Street 1:404 CARANEL CIRCLE
Practice Address - Street 2:
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072
Practice Address - Country:US
Practice Address - Phone:610-329-7251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS001317L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0684970Medicaid
PAMDCGO41316Medicare Oscar/Certification
PA0684970Medicaid