Provider Demographics
NPI:1275526311
Name:GOLEY, NANCY (CNM)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:GOLEY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:394 OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-1757
Mailing Address - Country:US
Mailing Address - Phone:516-742-2224
Mailing Address - Fax:516-742-7470
Practice Address - Street 1:394 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-1757
Practice Address - Country:US
Practice Address - Phone:516-742-2224
Practice Address - Fax:516-742-7470
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000825367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02339215Medicaid
NY02339215Medicaid
MFM161Medicare ID - Type Unspecified