Provider Demographics
NPI:1902886401
Name:MYRON W. GOLDSTEIN RPT
Entity Type:Organization
Organization Name:MYRON W. GOLDSTEIN RPT
Other - Org Name:HOPE PHYSICAL & AQUATIC THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:516-681-5225
Mailing Address - Street 1:2 HOPE DR
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-5626
Mailing Address - Country:US
Mailing Address - Phone:516-681-5225
Mailing Address - Fax:516-681-5463
Practice Address - Street 1:2 HOPE DR
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-5626
Practice Address - Country:US
Practice Address - Phone:516-681-5225
Practice Address - Fax:516-681-5463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQWGG1Medicare ID - Type UnspecifiedGROUP