Provider Demographics
NPI:1194054221
Name:GOLDMAN, ANDREA LEE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:LEE
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ALOMA RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11778-9619
Mailing Address - Country:US
Mailing Address - Phone:631-849-4536
Mailing Address - Fax:
Practice Address - Street 1:15 ALOMA RD
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778-9619
Practice Address - Country:US
Practice Address - Phone:631-849-4536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-21
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY623720163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health