Provider Demographics
NPI:1154756112
Name:GOLDSTEIN, LEONARD BARRY (DDS, PHD)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:BARRY
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 PARK PL
Mailing Address - Street 2:#1EE
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5021
Mailing Address - Country:US
Mailing Address - Phone:516-686-1408
Mailing Address - Fax:516-686-3833
Practice Address - Street 1:25 PARK PL
Practice Address - Street 2:#1EE
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5021
Practice Address - Country:US
Practice Address - Phone:516-686-1408
Practice Address - Fax:516-686-3833
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026952122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY026952OtherNEW YORK STATE LICENSE NUMBER
NY026952OtherNEW YORK STATE LICENSE NUMBER