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NPI Code Detail

MEDICARE: MR. TIRAS GOODWIN RN

MEDICARE: MR. TIRAS GOODWIN RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse737484NY

General Provider Information

NPI Number : 1013433036
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TIRAS GOODWIN RN
Provider Business Mailing Address
First Line : 14202 20TH AVE
Second Line :
City : FLUSHING
State : NY
Zip : 11351-3000
Country : US
Telephone Number : 718-559-0516
Fax Number :
Provider Business Practice Location Address
First Line : 10154 117TH ST
Second Line :
City : SOUTH RICHMOND HILL
State : NY
Zip : 11419-1906
Country : US
Telephone Number : 718-846-4007
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2017
Last Update Date : 08/22/2017

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