Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 25MA09930200 | NJ |
Y | 208600000X | Surgeon | 25MA09930200 | NJ |
N | 2086S0102X | Surgical Critical Care | 25MA09930200 | NJ |
N | 2086S0127X | Trauma Surgeon | 25MA09930200 | NJ |
NPI | 1336434257 |
---|---|
Provider Name | Nicole Goulet |
First Address | Newark, NJ 07103-2757 |
Second Address | Brooklyn, NY 11220-2508 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2011 |
Last Update Date | 01/04/2021 |