Provider Demographics
NPI:1831158088
Name:GOLDSTEIN, JEFFREY L (DO)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:L
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E 69TH ST
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5471
Mailing Address - Country:US
Mailing Address - Phone:212-327-1613
Mailing Address - Fax:212-327-1613
Practice Address - Street 1:201 E 69TH ST
Practice Address - Street 2:SUITE 2C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5471
Practice Address - Country:US
Practice Address - Phone:212-327-1613
Practice Address - Fax:212-327-1613
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY217381-1207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0423Q1OtherBLUECROSS BLUESHIELD
NY02374289Medicaid
NY02374289Medicaid
82S751Medicare PIN