Provider Demographics
NPI:1871586099
Name:GOLDSTEIN, HENRY R (MD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:R
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:123 PIKE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PORT JERVIS
Mailing Address - State:NY
Mailing Address - Zip Code:12771-1824
Mailing Address - Country:US
Mailing Address - Phone:845-856-6609
Mailing Address - Fax:845-856-6609
Practice Address - Street 1:123 PIKE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-1824
Practice Address - Country:US
Practice Address - Phone:845-856-6609
Practice Address - Fax:845-856-6609
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NY106783207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00492246Medicaid
24986Medicare UPIN
NY633331Medicare ID - Type Unspecified