Healthcare Provider Details

I. General information

NPI: 1659158624
Provider Name (Legal Business Name): NORTH ISLAND FAMILY HEALTH NP AND PODIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 NOSTRAND AVE FL 2
BROOKLYN NY
11216-4203
US

IV. Provider business mailing address

596 PENNSYLVANIA AVE
BROOKLYN NY
11207-6308
US

V. Phone/Fax

Practice location:
  • Phone: 718-783-4780
  • Fax:
Mailing address:
  • Phone: 347-442-5847
  • Fax: 718-819-1818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN GOODEN
Title or Position: COO
Credential: MHA
Phone: 516-984-9771