Provider Demographics
NPI:1063410645
Name:GOLDSTEIN, MICHAEL JOEL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOEL
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:310 E SHORE RD
Mailing Address - Street 2:206
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-2432
Mailing Address - Country:US
Mailing Address - Phone:516-487-7677
Mailing Address - Fax:516-487-2868
Practice Address - Street 1:310 E SHORE RD
Practice Address - Street 2:206
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-2432
Practice Address - Country:US
Practice Address - Phone:516-487-7677
Practice Address - Fax:516-487-2868
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY087746207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC10810Medicare UPIN
NY516381Medicare ID - Type Unspecified