Provider Demographics
NPI:1962410068
Name:GOLDSTEIN, LAURIE RUTH (MD)
Entity type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:RUTH
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 E 89TH ST APT 5G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-7911
Mailing Address - Country:US
Mailing Address - Phone:212-427-7050
Mailing Address - Fax:
Practice Address - Street 1:134 E 93RD ST
Practice Address - Street 2:2ND FL.
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1635
Practice Address - Country:US
Practice Address - Phone:212-348-7800
Practice Address - Fax:212-348-8043
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147058207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC09798Medicare UPIN
NY43D821Medicare ID - Type Unspecified