MEDICARE: DR. JEFFREY A GOLDSTEIN MD

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	196712	NY
2	207RG0100X	Gastroenterology Physician	196712-1	NY
3	207RG0100X	Gastroenterology Physician	ME76574	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184677957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY A GOLDSTEIN MD

Provider Business Mailing Address
First Line	:	1425 PORTLAND AVE
Second Line	:	BOX 242
City	:	ROCHESTER
State	:	NY
Zip	:	14621-3001
Country	:	US
Telephone Number	:	585-922-4198
Fax Number	:	585-922-5761

Provider Business Practice Location Address
First Line	:	1070 N STONE ST STE D
Second Line	:
City	:	DELAND
State	:	FL
Zip	:	32720-0824
Country	:	US
Telephone Number	:	386-943-3270
Fax Number	:	386-822-9112

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	07/16/2025

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