Healthcare Provider Details

I. General information

NPI: 1225747546
Provider Name (Legal Business Name): LAURA ANGLEA GOOD CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2022
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 3RD ST
BROOKLYN NY
11215-3003
US

IV. Provider business mailing address

5924 68TH RD
RIDGEWOOD NY
11385-4446
US

V. Phone/Fax

Practice location:
  • Phone: 718-768-8500
  • Fax:
Mailing address:
  • Phone: 781-264-3011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number002189
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: