Healthcare Provider Details

I. General information

NPI: 1962595132
Provider Name (Legal Business Name): DONALD NILES GOLDSCHEIN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/17/2015
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
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 TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number040353
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: