Healthcare Provider Details

I. General information

NPI: 1194075390
Provider Name (Legal Business Name): SHELDON L GOLDSTEIN VMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 09/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 GREENLEIGH DR
SEWELL NJ
08080-3211
US

IV. Provider business mailing address

40 GREENLEIGH DR
SEWELL NJ
08080-3211
US

V. Phone/Fax

Practice location:
  • Phone: 856-228-3329
  • Fax:
Mailing address:
  • Phone: 856-228-3329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number29VI00251000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: