MEDICARE: DR. ELLEN E GOLDSTEIN D.D.S.

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	1223G0001X	General Practice Dentistry	36377	NY

General Provider Information

NPI Number	:	1598821688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELLEN E GOLDSTEIN D.D.S.

Provider Business Mailing Address
First Line	:	200 PARK AVE S
Second Line	:	SUITE 1414
City	:	NEW YORK
State	:	NY
Zip	:	10003-1503
Country	:	US
Telephone Number	:	212-255-5730
Fax Number	:	212-533-8232

Provider Business Practice Location Address
First Line	:	200 PARK AVE S
Second Line	:	SUITE 1414
City	:	NEW YORK
State	:	NY
Zip	:	10003-1503
Country	:	US
Telephone Number	:	212-255-5730
Fax Number	:	212-533-8232

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

Provider Enumeration Date	:	12/31/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. ELLEN E GOLDSTEIN D.D.S.” Practice Location

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