Provider Demographics
NPI:1770590432
Name:GOLDSTEIN, MONTE (MD)
Entity type:Individual
Prefix:
First Name:MONTE
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 W MICHIGAN AVE
Mailing Address - Street 2:P. O. BOX 1123
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2218
Mailing Address - Country:US
Mailing Address - Phone:517-787-6440
Mailing Address - Fax:
Practice Address - Street 1:500 N FRANKLIN TPKE
Practice Address - Street 2:SUITE 206
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1177
Practice Address - Country:US
Practice Address - Phone:201-962-7282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06252400207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0016128Medicaid
E94803Medicare UPIN
NJ022983TRXMedicare ID - Type Unspecified