Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 332522 | NY |
NPI | 1003920604 |
---|---|
Provider Name | Michael Goins |
First Address | Brooklyn, NY 11201-5290 |
Second Address | New York, NY 10009-5335 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
LICENSE NUMBER | 332522 (01) | NY |