Organization
SPORTS MEDICINE ORTHOPAEDICS & PODIATRY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK D GOLDSTEIN MD (PRESIDENT)
(401) 383-7753
Entity
Organization
Contact information
Practice address
400 MASSASOIT AVENUE, SUITE 201, EAST PROVIDENCE, RI 02914-2012
(401) 383-7753
(401) 383-8982
Mailing address
400 MASSASOIT AVE STE 201, EAST PROVIDENCE, RI 02914-2020
(401) 383-7753
(401) 383-8982
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9020116
—
RI
Enumeration date
02/06/2008
Last updated
12/02/2021
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