Healthcare Provider Details

I. General information

NPI: 1669469581
Provider Name (Legal Business Name): MICHAEL BRUCE GOLDSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 E EVESHAM RD STE 110 BULIDING 800
VOORHEES NJ
08043-4502
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 856-772-1600
  • Fax: 856-772-9031
Mailing address:
  • Phone: 856-355-0340
  • Fax: 856-355-0330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MA04219200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: