MEDICARE: SALINA P. GOH RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	382828	NY
2	163W00000X	Registered Nurse	722268	NY

General Provider Information

NPI Number	:	1255860128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALINA P. GOH RN

Provider Business Mailing Address
First Line	:	167 SANDS ST APT 316
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-7409
Country	:	US
Telephone Number	:	917-941-8850
Fax Number	:

Provider Business Practice Location Address
First Line	:	167 SANDS ST APT 316
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-7409
Country	:	US
Telephone Number	:	646-943-2012
Fax Number	:	646-943-2012

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2017
Last Update Date	:	02/04/2018

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