Provider Demographics
NPI:1548402928
Name:ALISSANDRATOS, GOLDIE (NP)
Entity Type:Individual
Prefix:
First Name:GOLDIE
Middle Name:
Last Name:ALISSANDRATOS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-7616
Mailing Address - Country:US
Mailing Address - Phone:914-831-4160
Mailing Address - Fax:914-831-4161
Practice Address - Street 1:73 MARKET ST
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-7616
Practice Address - Country:US
Practice Address - Phone:914-831-4160
Practice Address - Fax:914-831-4161
Is Sole Proprietor?:No
Enumeration Date:2009-03-31
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331331363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner