Healthcare Provider Details

I. General information

NPI: 1649680117
Provider Name (Legal Business Name): GELSEY L GOODSTEIN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2014
Last Update Date: 10/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD
WEST HOLLYWOOD CA
90048-1804
US

IV. Provider business mailing address

PO BOX 1997
BEVERLY HILLS CA
90213-1997
US

V. Phone/Fax

Practice location:
  • Phone: 323-656-1202
  • Fax:
Mailing address:
  • Phone: 323-656-1202
  • Fax:

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: GELSEY L GOODSTEIN
Title or Position: PRESIDENT
Credential: MD
Phone: 323-309-3859