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General NPI Number Information
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NPI Number | 1164579181
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Entity Type | Individual
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Provider Name | LEE J GOLDSTEIN MD
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Gender | Male
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 01/10/2020
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Provider Practice Location Address
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Address Line | 495 HAWLEY LN SUITE 2A
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City | STRATFORD
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State | CT
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Zip | 06614-1514
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Country | US
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Telephone | 203-210-6333
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Fax |
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Provider Business Mailing Address
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Address Line | 10 BRIANNA LN
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City | EASTON
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State | CT
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Zip | 06612-1660
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Country | US
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Telephone | 203-210-6333
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 52731
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License Number State | CT
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