Provider Demographics
NPI:1558626994
Name:GOLDSTEIN, JESSICA (MSED)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 WILMINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4032
Mailing Address - Country:US
Mailing Address - Phone:516-655-0056
Mailing Address - Fax:
Practice Address - Street 1:33 WILMINGTON DR
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-4032
Practice Address - Country:US
Practice Address - Phone:516-655-0056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist