Healthcare Provider Details

I. General information

NPI: 1003056904
Provider Name (Legal Business Name): LORETTA GOODMAN SALVAY R.N., F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2009
Last Update Date: 03/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 LAKEWOOD AVE
MONTICELLO NY
12701-2024
US

IV. Provider business mailing address

13 MAPLE AVE
WOODRIDGE NY
12789-0000
US

V. Phone/Fax

Practice location:
  • Phone: 845-323-5673
  • Fax:
Mailing address:
  • Phone: 845-436-6147
  • Fax: 845-436-6597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number335844
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: