Healthcare Provider Details

I. General information

NPI: 1811517436
Provider Name (Legal Business Name): ADAM GOLDSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 1ST ST
MINEOLA NY
11501-3957
US

IV. Provider business mailing address

985 CLARK PL
WOODMERE NY
11598-1428
US

V. Phone/Fax

Practice location:
  • Phone: 516-398-0479
  • Fax:
Mailing address:
  • Phone: 516-398-0479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number342050
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: