Provider Demographics
NPI:1457503039
Name:GODIN OSTRO, EVELYN R (MD)
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:R
Last Name:GODIN OSTRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 W SHORE DR
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-2118
Mailing Address - Country:US
Mailing Address - Phone:609-737-1568
Mailing Address - Fax:
Practice Address - Street 1:23 W SHORE DR
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-2118
Practice Address - Country:US
Practice Address - Phone:609-737-1568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA41818174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist