Provider Demographics
NPI:1982609749
Name:GOLDSTEIN, MERVYN LEON (MD)
Entity Type:Individual
Prefix:DR
First Name:MERVYN
Middle Name:LEON
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:53 WINDING RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603-2853
Mailing Address - Country:US
Mailing Address - Phone:914-948-0373
Mailing Address - Fax:914-948-0374
Practice Address - Street 1:53 WINDING RIDGE RD
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10603-2853
Practice Address - Country:US
Practice Address - Phone:914-948-0373
Practice Address - Fax:914-948-0374
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY086816207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00135433Medicaid
NY165561Medicare ID - Type UnspecifiedMEDICARE
NYC06205Medicare UPIN