Healthcare Provider Details

I. General information

NPI: 1609836493
Provider Name (Legal Business Name): DENISE GOLDSTEIN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 N VAN DIEN AVE CARDIOTHORACIC SURGERY OFFICE
RIDGEWOOD NJ
07450-2726
US

IV. Provider business mailing address

43 LADY GODIVA WAY
NEW CITY NY
10956-6349
US

V. Phone/Fax

Practice location:
  • Phone: 201-447-8418
  • Fax: 201-447-8658
Mailing address:
  • Phone: 845-634-7608
  • Fax: 845-323-4105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number26NJ00045100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: