Provider Demographics
NPI:1841628849
Name:GOLDSTEIN, RAQUEL KARA (RPA-C)
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:KARA
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HARVARD RD
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1926
Mailing Address - Country:US
Mailing Address - Phone:917-826-9999
Mailing Address - Fax:
Practice Address - Street 1:2500 MARCUS AVE STE 105
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1018
Practice Address - Country:US
Practice Address - Phone:516-358-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-29
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017151363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant