Provider Demographics
NPI:1558909895
Name:GOODMAN, BEATRICE (BSN RN)
Entity Type:Individual
Prefix:MS
First Name:BEATRICE
Middle Name:
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:
Other - First Name:BEATRICE
Other - Middle Name:
Other - Last Name:GOODMAN RUSSELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN BSN
Mailing Address - Street 1:126 STANTON BLVD
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-2733
Mailing Address - Country:US
Mailing Address - Phone:631-796-4716
Mailing Address - Fax:
Practice Address - Street 1:126 STANTON BLVD
Practice Address - Street 2:
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-2733
Practice Address - Country:US
Practice Address - Phone:631-796-4716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY517212163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse