MEDICARE: DR. MERVYN LEON 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	207RH0000X	Hematology (Internal Medicine) Physician	086816	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	:	1982609749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MERVYN LEON GOLDSTEIN M.D.

Provider Business Mailing Address
First Line	:	53 WINDING RIDGE RD
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10603-2853
Country	:	US
Telephone Number	:	914-948-0373
Fax Number	:	914-948-0374

Provider Business Practice Location Address
First Line	:	53 WINDING RIDGE RD
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10603-2853
Country	:	US
Telephone Number	:	914-948-0373
Fax Number	:	914-948-0374

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	07/09/2007

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