Healthcare Provider Details

I. General information

NPI: 1770569568
Provider Name (Legal Business Name): MARC GOLDSTEIN D.O.C.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 KENNEDY BLVD
NORTH BERGEN NJ
07047-4254
US

IV. Provider business mailing address

8100 KENNEDY BLVD
NORTH BERGEN NJ
07047-4254
US

V. Phone/Fax

Practice location:
  • Phone: 201-866-6770
  • Fax: 201-866-6771
Mailing address:
  • Phone: 201-866-6770
  • Fax: 201-866-6771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMB03186200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberMB03186200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: