Healthcare Provider Details

I. General information

NPI: 1174656946
Provider Name (Legal Business Name): IRWIN GOLDSCHEIN DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 05/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 FORT HAMILTON PARKWAY
BROOKLYN NY
11219-0397
US

IV. Provider business mailing address

4901 FORT HAMILTON PARKWAY PO BOX 190 397 1
BROOKLYN NY
11219-0397
US

V. Phone/Fax

Practice location:
  • Phone: 718-438-3701
  • Fax: 718-854-7108
Mailing address:
  • Phone: 718-438-3701
  • Fax: 718-854-7108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. DONALD GOLDSCHEIN
Title or Position: PRESIDENT
Credential: DDS
Phone: 718-438-3701