Healthcare Provider Details

I. General information

NPI: 1982145942
Provider Name (Legal Business Name): JENNIFER SARA GOLDSTEIN RN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2017
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 WILDWOOD DR
POUGHKEEPSIE NY
12603-5828
US

IV. Provider business mailing address

14 WILDWOOD DR
POUGHKEEPSIE NY
12603-5828
US

V. Phone/Fax

Practice location:
  • Phone: 845-662-1573
  • Fax:
Mailing address:
  • Phone: 845-662-1573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number348645
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number715087
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: