Healthcare Provider Details

I. General information

NPI: 1730496365
Provider Name (Legal Business Name): FLORA J. GOLDSTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2010
Last Update Date: 09/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PELHAM PKWY S
BRONX NY
10461-1138
US

IV. Provider business mailing address

1565 ODELL ST APT 5D
BRONX NY
10462-7032
US

V. Phone/Fax

Practice location:
  • Phone: 718-792-0100
  • Fax:
Mailing address:
  • Phone: 718-892-1674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number439873-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: