Provider Demographics
NPI:1427899475
Name:GOFF, STEWART R (MS, RN)
Entity type:Individual
Prefix:
First Name:STEWART
Middle Name:R
Last Name:GOFF
Suffix:
Gender:M
Credentials:MS, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 PARK ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-4406
Mailing Address - Country:US
Mailing Address - Phone:617-991-2579
Mailing Address - Fax:
Practice Address - Street 1:99 PARK ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-4406
Practice Address - Country:US
Practice Address - Phone:617-991-2579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MANH2928376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator