Provider Demographics
NPI:1285664565
Name:GOLDSTEIN, EDWARD (RPA-C)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2365 S CLINTON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2663
Mailing Address - Country:US
Mailing Address - Phone:585-442-5320
Mailing Address - Fax:585-442-5526
Practice Address - Street 1:1425 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3011
Practice Address - Country:US
Practice Address - Phone:585-922-9080
Practice Address - Fax:585-922-4012
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001919363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q32129Medicare UPIN
NYPA0601-GRP:70008AMedicare PIN
NYPA0602-GRP:BA0017Medicare PIN