Healthcare Provider Details

I. General information

NPI: 1083762173
Provider Name (Legal Business Name): CAROL JOAN GOLDBLATT I R.N., M.S., A.P.N.C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117-119 ROOSEVELT AVE
PLAINFIELD NJ
07060
US

IV. Provider business mailing address

162 JUPITOR ST
CLARK NJ
07066-3018
US

V. Phone/Fax

Practice location:
  • Phone: 908-756-6870
  • Fax: 908-756-5566
Mailing address:
  • Phone: 732-396-3149
  • Fax: 732-382-7209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number26NC03900200
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier6629806
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: