Provider Demographics
NPI:1982266631
Name:MITCHELL GOLDSTEIN, MD ORTHOPEDIC SURGERY AND SPORTS MEDICINE, PC
Entity Type:Organization
Organization Name:MITCHELL GOLDSTEIN, MD ORTHOPEDIC SURGERY AND SPORTS MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MD
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:NILES
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-855-5880
Mailing Address - Street 1:1133 HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-2622
Mailing Address - Country:US
Mailing Address - Phone:516-816-7878
Mailing Address - Fax:516-855-5881
Practice Address - Street 1:325 MERRICK AVE STE 3
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-1556
Practice Address - Country:US
Practice Address - Phone:516-855-5880
Practice Address - Fax:516-855-5881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty