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General NPI Number Information
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NPI Number | 1356170948
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Entity Type | Organization
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Legal Business Name | GOOSE STAFF MEDICAL LLC
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Dates
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Enumeration Date | 07/31/2024
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Last Update Date | 07/31/2024
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Provider Practice Location Address
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Address Line | 839 EMPIRE BLVD
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City | BROOKLYN
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State | NY
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Zip | 11213-5653
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Country | US
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Telephone | 347-789-9578
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Fax | 718-498-7927
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Provider Business Mailing Address
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Address Line | 839 EMPIRE BLVD
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City | BROOKLYN
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State | NY
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Zip | 11213-5653
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Country | US
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Telephone | 347-789-9578
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Fax | 718-498-7927
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Authorized Official
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Title or Position | PRESIDENT
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Name | JONATHAN MALINAS
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Credential |
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Telephone | 347-789-9578
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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