MEDICARE: REBECCA GOFFRED I

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	174400000X	Specialist	1888421251	NY

General Provider Information

NPI Number	:	1679374896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA GOFFRED I

Provider Business Mailing Address
First Line	:	15937 92ND ST
Second Line	:
City	:	HOWARD BEACH
State	:	NY
Zip	:	11414-3123
Country	:	US
Telephone Number	:	516-317-7975
Fax Number	:

Provider Business Practice Location Address
First Line	:	15937 92ND ST
Second Line	:
City	:	HOWARD BEACH
State	:	NY
Zip	:	11414-3123
Country	:	US
Telephone Number	:	516-317-7975
Fax Number	:

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

Provider Enumeration Date	:	03/24/2025
Last Update Date	:	03/24/2025

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Directions to “ REBECCA GOFFRED I ” Practice Location

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