Provider Demographics
NPI:1598277451
Name:GOLDFARB, MILDRED PEARL
Entity Type:Individual
Prefix:MRS
First Name:MILDRED
Middle Name:PEARL
Last Name:GOLDFARB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 RUMFORD RD
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-4115
Mailing Address - Country:US
Mailing Address - Phone:631-875-9291
Mailing Address - Fax:
Practice Address - Street 1:73 RUMFORD RD
Practice Address - Street 2:
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754-4115
Practice Address - Country:US
Practice Address - Phone:631-875-9291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist