Provider Demographics
NPI:1053386110
Name:JEFFREY A & MARK GOLDSTEIN DDS PLLC
Entity type:Organization
Organization Name:JEFFREY A & MARK GOLDSTEIN DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-322-9607
Mailing Address - Street 1:131-11 ROCKAWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:SO OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420
Mailing Address - Country:US
Mailing Address - Phone:718-322-9607
Mailing Address - Fax:718-322-9614
Practice Address - Street 1:131-11 ROCKAWAY BLVD
Practice Address - Street 2:
Practice Address - City:SO OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420
Practice Address - Country:US
Practice Address - Phone:718-322-9607
Practice Address - Fax:718-322-9614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028052122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00287967Medicaid