Provider Demographics
NPI:1164712386
Name:GOLDMAN, JILL S (MS, MPHIL)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:S
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:MS, MPHIL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 W 168TH ST
Mailing Address - Street 2:P & S BOX 16
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3725
Mailing Address - Country:US
Mailing Address - Phone:212-305-7382
Mailing Address - Fax:212-342-5144
Practice Address - Street 1:630 W 168TH ST
Practice Address - Street 2:P & S BOX 16
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3725
Practice Address - Country:US
Practice Address - Phone:212-305-7382
Practice Address - Fax:212-342-5144
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS