Provider Demographics
NPI:1215301809
Name:GOURARIE, ESTHER
Entity type:Individual
Prefix:
First Name:ESTHER
Middle Name:
Last Name:GOURARIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1198 CARROLL ST APT 6F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-2298
Mailing Address - Country:US
Mailing Address - Phone:773-805-2934
Mailing Address - Fax:
Practice Address - Street 1:1198 CARROLL ST
Practice Address - Street 2:APT 6F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-2248
Practice Address - Country:US
Practice Address - Phone:773-805-2934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-19
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY694276-1163W00000X
NYF350347-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY694276-1OtherLICENSE#