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General NPI Number Information
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NPI Number | 1649494642
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Entity Type | Organization
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Legal Business Name | SUSAN F GOLDSTEIN DO
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 525 NORTHERN BLVD SUITE 001
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City | GREAT NECK
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State | NY
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Zip | 11021-5102
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Country | US
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Telephone | 516-487-5675
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Fax |
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Provider Business Mailing Address
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Address Line | 525 NORTHERN BLVD SUITE 001
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City | GREAT NECK
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State | NY
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Zip | 11021-5102
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Country | US
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Telephone | 516-487-5675
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SUSAN FREYDA GOLDSTEIN
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Credential | DO
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Telephone | 516-487-5675
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | 154564
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License Number State | NY
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