Provider Demographics
NPI:1447336656
Name:GOLDSTEIN, ERIC (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:371 MERRICK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-5359
Mailing Address - Country:US
Mailing Address - Phone:516-442-7444
Mailing Address - Fax:516-442-7447
Practice Address - Street 1:371 MERRICK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-5359
Practice Address - Country:US
Practice Address - Phone:516-442-7444
Practice Address - Fax:516-442-7447
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231314208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02526763Medicaid