MEDICARE: DR. BARRY M GOLDSTEIN D.D.S.

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	1223P0700X	Prosthodontics	33766	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	13-3150465	OTHER	NY	METLIFE
2	13-3150465	OTHER	NY	AETNA
3	13-3150465	OTHER	NY	GUARDIAN
4	13-3150465	OTHER	NY	DELTA DENTAL

General Provider Information

NPI Number	:	1902996143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARRY M GOLDSTEIN D.D.S.

Provider Business Mailing Address
First Line	:	30 N GREELEY AVE
Second Line	:
City	:	CHAPPAQUA
State	:	NY
Zip	:	10514-3410
Country	:	US
Telephone Number	:	914-238-8200
Fax Number	:	914-238-1997

Provider Business Practice Location Address
First Line	:	30 N GREELEY AVE
Second Line	:
City	:	CHAPPAQUA
State	:	NY
Zip	:	10514-3410
Country	:	US
Telephone Number	:	914-238-8200
Fax Number	:	914-238-1997

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	05/13/2008

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