Provider Demographics
NPI:1457556797
Name:ERIC S. GOLDSTEIN, M.D., P.L.L.C.
Entity Type:Organization
Organization Name:ERIC S. GOLDSTEIN, M.D., P.L.L.C.
Other - Org Name:EAST RIVER GASTROENTEROLOGY AND NUTRITION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:SIMON
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-535-4500
Mailing Address - Street 1:1974 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6430
Mailing Address - Country:US
Mailing Address - Phone:212-535-4500
Mailing Address - Fax:212-535-4515
Practice Address - Street 1:1974 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6430
Practice Address - Country:US
Practice Address - Phone:212-535-4500
Practice Address - Fax:212-535-4515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214600207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI03776Medicare UPIN
NY4V2131Medicare ID - Type Unspecified