Provider Demographics
NPI:1174300818
Name:GOLDSTEIN, BRIANNA NATALIE
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:NATALIE
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 SEGUINE LOOP
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-3741
Mailing Address - Country:US
Mailing Address - Phone:917-880-9972
Mailing Address - Fax:
Practice Address - Street 1:106 SEGUINE LOOP
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-3741
Practice Address - Country:US
Practice Address - Phone:917-880-9972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-14
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant