Provider Demographics
NPI:1649322256
Name:GOLDSTEIN, MARJORIE (MA, PT)
Entity type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:MA, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 IROQUOIS AVE
Mailing Address - Street 2:
Mailing Address - City:PALISADES
Mailing Address - State:NY
Mailing Address - Zip Code:10964-1407
Mailing Address - Country:US
Mailing Address - Phone:845-359-9232
Mailing Address - Fax:
Practice Address - Street 1:220 KNICKERBOCKER RD
Practice Address - Street 2:
Practice Address - City:CRESSKILL
Practice Address - State:NJ
Practice Address - Zip Code:07626-1827
Practice Address - Country:US
Practice Address - Phone:201-541-9222
Practice Address - Fax:201-541-1711
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00165400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist