Provider Demographics
NPI:1548343304
Name:GOLDSTEIN, STANLEY (MD)
Entity type:Individual
Prefix:DR
First Name:STANLEY
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 1:242 MERRICK ROAD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570
Mailing Address - Country:US
Mailing Address - Phone:516-536-7336
Mailing Address - Fax:516-536-7650
Practice Address - Street 1:242 MERRICK ROAD
Practice Address - Street 2:SUITE 401
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570
Practice Address - Country:US
Practice Address - Phone:516-536-7336
Practice Address - Fax:516-536-7650
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY128390207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00489890Medicaid
A62305Medicare UPIN
NY34A471Medicare ID - Type Unspecified