Healthcare Provider Details

I. General information

NPI: 1679404032
Provider Name (Legal Business Name): MINNA GOLDSTONE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

368 RUTHERFORD BLVD #1
CLIFTON NJ
07014-1221
US

IV. Provider business mailing address

368 RUTHERFORD BLVD
CLIFTON NJ
07014-1221
US

V. Phone/Fax

Practice location:
  • Phone: 314-578-3150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number661619
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: