Provider Demographics
NPI:1699097535
Name:GOLDSTEIN, BRENDA SUE
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:SUE
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:SUE
Other - Last Name:GOLDSTEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:17 WOODRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10918-4312
Mailing Address - Country:US
Mailing Address - Phone:845-497-7239
Mailing Address - Fax:
Practice Address - Street 1:17 WOODRIDGE DR
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10918-4312
Practice Address - Country:US
Practice Address - Phone:845-497-7239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY258268164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse