Healthcare Provider Details

I. General information

NPI: 1043247828
Provider Name (Legal Business Name): PERRY CHET GOLDSTEIN RN, BSN,CMSRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 01/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

647 US ROUTE 1 #14149
YORK ME
03909-1689
US

IV. Provider business mailing address

647 US ROUTE 1 #14149
YORK ME
03909-1689
US

V. Phone/Fax

Practice location:
  • Phone: 207-272-4787
  • Fax: 207-221-1273
Mailing address:
  • Phone: 207-272-4787
  • Fax: 207-221-1273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN 52296
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN 52296
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN 52296
License Number StateME
# 4
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberRN 52296
License Number StateME
# 5
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN 52296
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: