Provider Demographics
NPI:1730421611
Name:GOLDSTEIN, GWEN L (MS)
Entity type:Individual
Prefix:MS
First Name:GWEN
Middle Name:L
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 TECHNOLOGY DR
Mailing Address - Street 2:DIV. OF GENETIC COUNSELING
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-4079
Mailing Address - Country:US
Mailing Address - Phone:631-444-2790
Mailing Address - Fax:
Practice Address - Street 1:6 TECHNOLOGY DR
Practice Address - Street 2:DIV. OF GENETIC COUNSELING
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-4079
Practice Address - Country:US
Practice Address - Phone:631-444-2790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS