Healthcare Provider Details

I. General information

NPI: 1063453348
Provider Name (Legal Business Name): DAVID GOLDSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 04/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

452 OLD HOOK RD 2ND FLOOR
EMERSON NJ
07630-1381
US

IV. Provider business mailing address

PO BOX 419430
BOSTON MA
02241-9430
US

V. Phone/Fax

Practice location:
  • Phone: 201-666-3900
  • Fax: 201-261-0505
Mailing address:
  • Phone: 201-666-3900
  • Fax: 201-261-0505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMA44408
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: