Provider Demographics
NPI:1629276910
Name:GOYETTE, MICHAEL DAVID (LPN)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DAVID
Last Name:GOYETTE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3251 CHAPMAN RD
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:NY
Mailing Address - Zip Code:14805-9747
Mailing Address - Country:US
Mailing Address - Phone:607-882-0285
Mailing Address - Fax:
Practice Address - Street 1:3251 CHAPMAN RD
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:NY
Practice Address - Zip Code:14805-9747
Practice Address - Country:US
Practice Address - Phone:607-882-0285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY286699164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02841183Medicaid