Provider Demographics
NPI:1366528127
Name:GOLDSTEIN, IRWIN (MD)
Entity type:Individual
Prefix:DR
First Name:IRWIN
Middle Name:
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 1:2044 KIRKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-4327
Mailing Address - Country:US
Mailing Address - Phone:516-868-7505
Mailing Address - Fax:
Practice Address - Street 1:79 GRAND AVE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-4905
Practice Address - Country:US
Practice Address - Phone:516-798-3376
Practice Address - Fax:516-798-5882
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175807207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBG2255001OtherDEA NUMBER
NYBG2255001OtherDEA NUMBER