MEDICARE: HENRY R 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	207W00000X	Ophthalmology Physician	106783	NY

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	:	1871586099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HENRY R GOLDSTEIN MD

Provider Business Mailing Address
First Line	:	123 PIKE ST
Second Line	:	SUITE 201
City	:	PORT JERVIS
State	:	NY
Zip	:	12771-1824
Country	:	US
Telephone Number	:	845-856-6609
Fax Number	:	845-856-6609

Provider Business Practice Location Address
First Line	:	123 PIKE ST
Second Line	:	SUITE 201
City	:	PORT JERVIS
State	:	NY
Zip	:	12771-1824
Country	:	US
Telephone Number	:	845-856-6609
Fax Number	:	845-856-6609

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

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	07/08/2007

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