MEDICARE: MICHAL GOLDSTEIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0019X	Physical Rehabilitation Occupational Therapist	022552	NY
2	225XP0019X	Physical Rehabilitation Occupational Therapist		TX

General Provider Information

NPI Number	:	1376023846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAL GOLDSTEIN

Provider Business Mailing Address
First Line	:	215 W 101ST ST APT 2F
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-5045
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 W 101ST ST APT 2F
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-5045
Country	:	US
Telephone Number	:	201-925-0219
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2018
Last Update Date	:	08/15/2018

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Directions to “ MICHAL GOLDSTEIN ” Practice Location

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