Healthcare Provider Details

I. General information

NPI: 1720273410
Provider Name (Legal Business Name): JASON SCOTT GOLDSTEIN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 02/11/2020
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 W 54TH ST FLOOR 3
NEW YORK NY
10019-5515
US

IV. Provider business mailing address

330 W 58TH ST APT 501
NEW YORK NY
10019-1818
US

V. Phone/Fax

Practice location:
  • Phone: 917-572-5834
  • Fax: 212-262-9178
Mailing address:
  • Phone: 212-582-1122
  • Fax: 212-582-1122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number011443
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: