MEDICARE: DANA C GOIDEL

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
1	363LF0000X	Family Nurse Practitioner	345632	NY

General Provider Information

NPI Number	:	1356976104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA C GOIDEL

Provider Business Mailing Address
First Line	:	104 MEMPHIS AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-3404
Country	:	US
Telephone Number	:	917-209-6644
Fax Number	:	718-317-0686

Provider Business Practice Location Address
First Line	:	104 MEMPHIS AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-3404
Country	:	US
Telephone Number	:	917-209-6644
Fax Number	:	718-317-0686

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2020
Last Update Date	:	03/11/2020

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Directions to “ DANA C GOIDEL ” Practice Location

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