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General NPI Number Information
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NPI Number | 1154834497
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Entity Type | Individual
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Provider Name | MICHELLE GOFMAN MSSPED
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Gender | Female
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Dates
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Enumeration Date | 11/08/2017
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Last Update Date | 11/23/2021
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Provider Practice Location Address
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Address Line | 2035 E 7TH ST APT 6J
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City | BROOKLYN
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State | NY
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Zip | 11223-3102
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Country | US
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Telephone | 718-419-1171
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Fax |
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Provider Business Mailing Address
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Address Line | 19 SHERWOOD LN
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City | OLD BRIDGE
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State | NJ
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Zip | 08857-1635
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Country | US
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Telephone |
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 2760645
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License Number State | NY
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