Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 059235-1 | NY |
NPI | 1073030540 |
---|---|
Provider Name | Rebecca Goldman |
First Address | Brooklyn, NY 11229-2516 |
Second Address | Brooklyn, NY 11229-2516 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2017 |
Last Update Date | 25/08/2017 |