Provider Demographics
NPI:1316066053
Name:GOLDSTEIN, HOWARD MARK (MD)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:MARK
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 HILLSIDE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:WILLISTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11596-2311
Mailing Address - Country:US
Mailing Address - Phone:516-746-4080
Mailing Address - Fax:516-877-7038
Practice Address - Street 1:105 HILLSIDE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:WILLISTON PARK
Practice Address - State:NY
Practice Address - Zip Code:11596-2311
Practice Address - Country:US
Practice Address - Phone:516-746-4080
Practice Address - Fax:516-877-7038
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143926207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00920512Medicaid
NY49D161OtherEMPIRE BLUECROSS
NYC10388Medicare UPIN
NY49D161Medicare ID - Type Unspecified