Provider Demographics
NPI:1033673116
Name:GOLDRICH, NINA (RN)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:GOLDRICH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 SUNNY LN
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-7616
Mailing Address - Country:US
Mailing Address - Phone:212-920-4363
Mailing Address - Fax:
Practice Address - Street 1:885 HAMPSHIRE RD
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-7631
Practice Address - Country:US
Practice Address - Phone:631-968-1247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY558306163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool