Active NPI
Peter Goldstein, RPH
- Pharmacist
- Port Jefferson, NY
National Provider Identifier
1457483018
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 036072
- Practice address
- 19 Shady Tree LN
Port Jefferson, NY 11777-1923 - Phone
- (631) 474-3780
- NPI assigned
- Mar 9, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 036072 | NY | Primary |
Addresses
Primary practice location
19 Shady Tree LN
Port Jefferson, NY 11777-1923
Mailing address
19 Shady Tree LN
Port Jefferson, NY 11777-1923
Phone (631) 474-3780
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036072 | NY | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173398400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1457483018",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19 SHADY TREE LN",
"city": "PORT JEFFERSON",
"state": "NY",
"postal_code": "117771923",
"telephone_number": "631-474-3780"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19 SHADY TREE LN",
"city": "PORT JEFFERSON",
"state": "NY",
"postal_code": "117771923",
"telephone_number": "631-474-3780"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOLDSTEIN",
"first_name": "PETER",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "036072",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Jefferson, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.