1902005028 NPI number — STUART GOLDSTEIN D.O. INC.

Table of content: (NPI 1902005028)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902005028 NPI number — STUART GOLDSTEIN D.O. INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STUART GOLDSTEIN D.O. INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WHIPPLE MEDICAL CENTER
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902005028
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3731 WHIPPLE AVE NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44718-2933
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-324-0526
Provider Business Mailing Address Fax Number:
330-493-5680

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3731 WHIPPLE AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44718-2933
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-324-0526
Provider Business Practice Location Address Fax Number:
330-493-5680
Provider Enumeration Date:
07/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GOLDSTEIN
Authorized Official First Name:
STUART
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
330-324-0526

Provider Taxonomy Codes

  • Taxonomy code: 207QG0300X , with the licence number:  2610 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9917852 . This is a "MEDICARE GROUP PROVIDER N" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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