Provider Demographics
NPI:1679641989
Name:GOLDMAN, SHANI (RPN)
Entity type:Individual
Prefix:MS
First Name:SHANI
Middle Name:
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:RPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 KINGS HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234
Mailing Address - Country:US
Mailing Address - Phone:718-258-2588
Mailing Address - Fax:718-258-4138
Practice Address - Street 1:3131 KINGS HIGHWAY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234
Practice Address - Country:US
Practice Address - Phone:718-258-2588
Practice Address - Fax:718-258-4138
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006438208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q16666Medicare UPIN
5443L1Medicare ID - Type Unspecified