Healthcare Provider Details

I. General information

NPI: 1871208876
Provider Name (Legal Business Name): MS. ELIA TERESA GOFFI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 01/16/2023
Certification Date: 01/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 LEXINGTON AVE RM 14A
NEW YORK NY
10017-6526
US

IV. Provider business mailing address

4301 46TH ST APT 2H
SUNNYSIDE NY
11104-2079
US

V. Phone/Fax

Practice location:
  • Phone: 212-204-8430
  • Fax:
Mailing address:
  • Phone: 240-772-2104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: