Provider Demographics
NPI:1679374896
Name:GOFFRED, REBECCA I
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:GOFFRED
Suffix:I
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15937 92ND ST
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-3123
Mailing Address - Country:US
Mailing Address - Phone:516-317-7975
Mailing Address - Fax:
Practice Address - Street 1:15937 92ND ST
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-3123
Practice Address - Country:US
Practice Address - Phone:516-317-7975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1888421251174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist