Provider Demographics
NPI:1316774060
Name:JAY A GOLDSTEIN, MD LLC
Entity type:Organization
Organization Name:JAY A GOLDSTEIN, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-655-0525
Mailing Address - Street 1:67 UNION ST STE 501
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-7700
Mailing Address - Country:US
Mailing Address - Phone:508-655-0525
Mailing Address - Fax:508-647-0960
Practice Address - Street 1:67 UNION ST STE 501
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-7700
Practice Address - Country:US
Practice Address - Phone:508-655-0525
Practice Address - Fax:508-647-0960
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAY A GOLDSTEIN, MD LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty