Healthcare Provider Details

I. General information

NPI: 1407408636
Provider Name (Legal Business Name): RACHEL GOLDSTEIN CBC, CD, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 07/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3528 77TH ST APT 51
JACKSON HEIGHTS NY
11372-4580
US

IV. Provider business mailing address

PO BOX 720424
JACKSON HEIGHTS NY
11372-0424
US

V. Phone/Fax

Practice location:
  • Phone: 917-855-8865
  • Fax:
Mailing address:
  • Phone: 917-855-8865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: