MEDICARE: DR. MICHAEL JOEL GOLDSTEIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	087746	NY

General Provider Information

NPI Number	:	1063410645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL JOEL GOLDSTEIN M.D.

Provider Business Mailing Address
First Line	:	310 E SHORE RD
Second Line	:	206
City	:	GREAT NECK
State	:	NY
Zip	:	11023-2432
Country	:	US
Telephone Number	:	516-487-7677
Fax Number	:	516-487-2868

Provider Business Practice Location Address
First Line	:	310 E SHORE RD
Second Line	:	206
City	:	GREAT NECK
State	:	NY
Zip	:	11023-2432
Country	:	US
Telephone Number	:	516-487-7677
Fax Number	:	516-487-2868

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	12/16/2009

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