Provider Demographics
NPI:1386300069
Name:GODGART, KAREN EILEEN (HIS)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:EILEEN
Last Name:GODGART
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 HORNE TOOKE RD
Mailing Address - Street 2:
Mailing Address - City:PALISADES
Mailing Address - State:NY
Mailing Address - Zip Code:10964-1417
Mailing Address - Country:US
Mailing Address - Phone:323-868-5416
Mailing Address - Fax:
Practice Address - Street 1:179 CEDAR LN STE D2
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4304
Practice Address - Country:US
Practice Address - Phone:201-530-7532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MG00157700237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist