Provider Demographics
NPI:1861614398
Name:GOLDMAN, ANITA (NP)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-4605
Mailing Address - Country:US
Mailing Address - Phone:516-799-4500
Mailing Address - Fax:516-799-4570
Practice Address - Street 1:514 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-4605
Practice Address - Country:US
Practice Address - Phone:516-799-4500
Practice Address - Fax:516-799-4570
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330706363LF0000X
NY000030367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Not Answered367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife