Provider Demographics
NPI:1841338282
Name:GOLDSTEIN, CRAIG MICHAEL (PT)
Entity type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:MICHAEL
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:382 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-1379
Mailing Address - Country:US
Mailing Address - Phone:203-250-9663
Mailing Address - Fax:203-699-9641
Practice Address - Street 1:382 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-1379
Practice Address - Country:US
Practice Address - Phone:203-250-9663
Practice Address - Fax:203-699-9641
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0056782251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
12701OtherCIGNA ORTHONET
CT4209674Medicaid
080005678CT01OtherANTHEM BCBS
3672389002OtherCIGNA
754954OtherCONNECTICARE
237036OtherAETNA
100901OtherHEALTHNET ORTHONET
2V8125OtherHEALTHNET
6404292OtherUNITED HEALTH CARE
A2646342OtherOXFORD HEALTH CARE