Provider Demographics
NPI:1093063059
Name:GOLDISH, SERACH NAVAH (MA)
Entity Type:Individual
Prefix:MRS
First Name:SERACH
Middle Name:NAVAH
Last Name:GOLDISH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14426 76TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3116
Mailing Address - Country:US
Mailing Address - Phone:845-558-8140
Mailing Address - Fax:
Practice Address - Street 1:14426 76TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3116
Practice Address - Country:US
Practice Address - Phone:845-558-8140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-23
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1919642174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist