Provider Demographics
NPI:1649347790
Name:GOLDSTEIN, MELISSA JILL (MD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:JILL
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MELISSA
Other - Middle Name:JILL
Other - Last Name:FELDMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1125 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1243
Mailing Address - Country:US
Mailing Address - Phone:212-289-1400
Mailing Address - Fax:212-289-5714
Practice Address - Street 1:1125 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1243
Practice Address - Country:US
Practice Address - Phone:212-289-1400
Practice Address - Fax:212-289-5714
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219378208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics