=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033673116
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NINA GOLDRICH NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2019
-----------------------------------------------------
Last Update Date | 08/21/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6735 112TH ST
-----------------------------------------------------
City | FOREST HILLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11375-2349
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-263-0740
-----------------------------------------------------
Fax | 718-263-9894
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6735 112TH ST
-----------------------------------------------------
City | FOREST HILLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11375-2349
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-263-0740
-----------------------------------------------------
Fax | 718-263-9894
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Nurse Practitioner
-----------------------------------------------------
License Number | 383849
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------