| Doctor Name: | DR. EDWARD GOLDSTEIN |
| NPI Number: | 1689793093 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 161776 |
| Business Practice Address: | 80 State Highway 310 Suite 1 Canton, NY - 136171493 |
| Business Phone Number: | 3153862167 |
| Business Fax Number: | 3153862435 |
| Mailing Address: | 80 State Highway 310, Suite 1 CANTON |
| State: | NY |
| Postal Code: | 136171493 |
| Phone Number: | 3153862167 |
| Fax Number: | 3153862435 |
| NPI Enumeration Date: | 03/28/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 161776 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |