Healthcare Provider Details

I. General information

NPI: 1003992991
Provider Name (Legal Business Name): JEFFREY BRIAN GOLDSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 02/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MAMARONECK AVE SUITE 200
HARRISON NY
10528-1635
US

IV. Provider business mailing address

550 MAMARONECK AVE SUITE 302
HARRISON NY
10528-1634
US

V. Phone/Fax

Practice location:
  • Phone: 914-723-8100
  • Fax: 914-219-1928
Mailing address:
  • Phone: 914-723-8100
  • Fax: 914-219-1928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number159310
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: