Healthcare Provider Details

I. General information

NPI: 1356170948
Provider Name (Legal Business Name): GOOSE STAFF MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

839 EMPIRE BLVD
BROOKLYN NY
11213-5653
US

IV. Provider business mailing address

839 EMPIRE BLVD
BROOKLYN NY
11213-5653
US

V. Phone/Fax

Practice location:
  • Phone: 347-789-9578
  • Fax: 718-498-7927
Mailing address:
  • Phone: 347-789-9578
  • Fax: 718-498-7927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN MALINAS
Title or Position: PRESIDENT
Credential:
Phone: 347-789-9578