MEDICARE: DR. ZACHARY GOLDSTEIN PT, DPT

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	225100000X	Physical Therapist	PT028614	PA
2	225100000X	Physical Therapist	40QA01920600	NJ

General Provider Information

NPI Number	:	1225645989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ZACHARY GOLDSTEIN PT, DPT

Provider Business Mailing Address
First Line	:	222 UNION AVE
Second Line	:
City	:	BELLMAWR
State	:	NJ
Zip	:	08031-1620
Country	:	US
Telephone Number	:	856-495-1984
Fax Number	:	651-602-3669

Provider Business Practice Location Address
First Line	:	67 E KINGS HWY
Second Line	:
City	:	MAPLE SHADE
State	:	NJ
Zip	:	08052-2048
Country	:	US
Telephone Number	:	856-495-1984
Fax Number	:	651-602-3669

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

Provider Enumeration Date	:	09/28/2020
Last Update Date	:	09/28/2020

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