Healthcare Provider Details

I. General information

NPI: 1013087220
Provider Name (Legal Business Name): BONNIE GOLDSTEIN MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 E HENRIETTA RD
ROCHESTER NY
14620-4629
US

IV. Provider business mailing address

15 CHIPMUNK TRL
PITTSFORD NY
14534-3962
US

V. Phone/Fax

Practice location:
  • Phone: 585-760-6561
  • Fax:
Mailing address:
  • Phone: 585-586-5662
  • Fax: 585-760-6572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF301204-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: