Basic Information
| Provider Information | |||||||||
| NPI: | 1275506453 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOLDSTEIN | ||||||||
| FirstName: | KEITH | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 SAND HILL RD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | FLEMINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088224946 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082374080 | ||||||||
| FaxNumber: | 9082371749 | ||||||||
| Practice Location | |||||||||
| Address1: | 6 SAND HILL RD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | FLEMINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088224946 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082374080 | ||||||||
| FaxNumber: | 9082371749 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2006 | ||||||||
| LastUpdateDate: | 12/28/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | MA53231 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0652300-01 | 05 | NJ | MEDICAID |