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General NPI Number Information
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NPI Number | 1093212086
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Entity Type | Individual
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Provider Name | GENNADIY GOLDVEKHT NP
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Gender | Male
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Dates
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Enumeration Date | 04/06/2018
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Last Update Date | 04/06/2018
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Provider Practice Location Address
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Address Line | 3101 OCEAN PKWY APT 1A
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City | BROOKLYN
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State | NY
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Zip | 11235-8403
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Country | US
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Telephone | 718-946-2481
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Fax | 718-266-5346
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Provider Business Mailing Address
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Address Line | 3045 BRIGHTON 12TH ST APT 3I
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City | BROOKLYN
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State | NY
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Zip | 11235-5742
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Country | US
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Telephone | 917-945-9040
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | F304424-1
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License Number State | NY
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