# SPORTS MEDICINE ORTHOPAEDICS & PODIATRY INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407034994
- **Authorized official:** DR. JACK D GOLDSTEIN MD (PRESIDENT)
- **Authorized official phone:** (401) 383-7753

## Contact information

- **Practice address:** 400 MASSASOIT AVENUE, SUITE 201, EAST PROVIDENCE, RI 02914-2012
- **Practice address phone:** (401) 383-7753
- **Practice address fax:** (401) 383-8982
- **Mailing address:** 400 MASSASOIT AVE STE 201, EAST PROVIDENCE, RI 02914-2020
- **Mailing address phone:** (401) 383-7753
- **Mailing address fax:** (401) 383-8982

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/06/2008
- **Last updated:** 12/02/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 9020116 | — | RI |