Provider Demographics
NPI:1053662114
Name:GOFF, BERNADETTE FRANCIS
Entity Type:Individual
Prefix:MS
First Name:BERNADETTE
Middle Name:FRANCIS
Last Name:GOFF
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 1:249 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:WINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:12594-1836
Mailing Address - Country:US
Mailing Address - Phone:845-551-1528
Mailing Address - Fax:
Practice Address - Street 1:3 ROETHAL DR
Practice Address - Street 2:
Practice Address - City:HOPEWELL JCT
Practice Address - State:NY
Practice Address - Zip Code:12533-5854
Practice Address - Country:US
Practice Address - Phone:845-897-1788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY509751111174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist