Healthcare Provider Details

I. General information

NPI: 1952463200
Provider Name (Legal Business Name): MARK GOLDSTEIN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 FASHION AVE 1404A
NEW YORK NY
10018-4603
US

IV. Provider business mailing address

316 THE PROMENADE
EDGEWATER NJ
07020-2109
US

V. Phone/Fax

Practice location:
  • Phone: 212-768-7979
  • Fax: 212-768-1223
Mailing address:
  • Phone: 917-533-3197
  • Fax: 212-768-1223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberX009637-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: