Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 019.032977 | IL |
N | 1223S0112X | Oral and Maxillofacial Surgeon | DBS9273 | NY |
NPI | 1093104440 |
---|---|
Provider Name | Dr. Brian Goldstein |
First Address | Bellmore, NY 11710-5032 |
Second Address | Chicago, IL 60643-1013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2015 |
Last Update Date | 01/02/2021 |