=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366965154
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RONALD GOLDSTEIN OD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2017
-----------------------------------------------------
Last Update Date | 07/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 243 E 77TH ST STE 1A
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10075-2132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-249-0002
-----------------------------------------------------
Fax | 212-249-5248
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 243 E 77TH ST STE 1A
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10075-2132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-249-0002
-----------------------------------------------------
Fax | 212-249-5248
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | DANIELA CABRAL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 212-249-0002
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | TUV004856-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------