Provider Demographics
NPI:1962955682
Name:FOSTER FORD, GEORGETTE DIONICIA (RN)
Entity type:Individual
Prefix:
First Name:GEORGETTE
Middle Name:DIONICIA
Last Name:FOSTER FORD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 COOPER ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-1415
Mailing Address - Country:US
Mailing Address - Phone:646-932-8458
Mailing Address - Fax:
Practice Address - Street 1:16 W 36TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-8004
Practice Address - Country:US
Practice Address - Phone:212-719-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY585714163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool