Provider Demographics
NPI:1861543076
Name:GOLDSTEIN, SUSANNA K (MD)
Entity type:Individual
Prefix:DR
First Name:SUSANNA
Middle Name:K
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 CENTRAL PARK W
Mailing Address - Street 2:SUITE 1BR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-6007
Mailing Address - Country:US
Mailing Address - Phone:212-362-6657
Mailing Address - Fax:212-787-9781
Practice Address - Street 1:65 CENTRAL PARK W
Practice Address - Street 2:SUITE 1BR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-6007
Practice Address - Country:US
Practice Address - Phone:212-362-6657
Practice Address - Fax:212-787-9781
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1547351174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA98619Medicare UPIN
NY06D691Medicare ID - Type Unspecified