Provider Demographics
NPI:1881800464
Name:ABE GOLDSTEIN, MD PC
Entity type:Organization
Organization Name:ABE GOLDSTEIN, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-439-6780
Mailing Address - Street 1:2525 W BERYL AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-1606
Mailing Address - Country:US
Mailing Address - Phone:602-467-4756
Mailing Address - Fax:602-371-4960
Practice Address - Street 1:2525 W BERYL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-1606
Practice Address - Country:US
Practice Address - Phone:602-467-4756
Practice Address - Fax:602-371-4960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10160282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1457444937OtherNPI
AZ1881800464OtherNPI GROUP
AZZ114849Medicare PIN