Healthcare Provider Details

I. General information

NPI: 1467260372
Provider Name (Legal Business Name): DAWN GOLDSTEIN MC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2024
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

937 3RD STREET SUITE 307
SANTA MONICA CA
90403
US

IV. Provider business mailing address

560 HUDSON ST STE 301
HACKENSACK NJ
07601-6655
US

V. Phone/Fax

Practice location:
  • Phone: 973-214-3016
  • Fax:
Mailing address:
  • Phone: 201-641-2125
  • Fax: 212-888-6024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ROSE VELASQUEZ
Title or Position: ADMINISTRATION
Credential:
Phone: 201-641-2125