Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP0504X | Public Medicine | SC002852L | PA |
N | 213EP1101X | Primary Podiatric Medicine | SC002852L | PA |
N | 111NR0200X | Radiology | SC002852L | PA |
N | 213ER0200X | Radiology | SC002852L | PA |
N | 2081S0010X | Sports Medicine | SC002852L | PA |
N | 213ES0000X | Sports Medicine | SC002852L | PA |
Y | 213ES0103X | Foot & Ankle Surgery | SC002852L | PA |
N | 213ES0131X | Foot Surgery | SC002852L | PA |
NPI | 1093758021 |
---|---|
Provider Name | Dr. Brian Louis Goldstein |
First Address | Bala Cynwyd, PA 19004-2830 |
Second Address | Bala Cynwyd, PA 19004-2830 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 08/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001045750 | (05) | PA |
T72792 | (02) | PA |