Provider Demographics
NPI:1679204390
Name:GOEBEL, EMMA MARIE
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:MARIE
Last Name:GOEBEL
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 1:438 LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:HEWITT
Mailing Address - State:NJ
Mailing Address - Zip Code:07421-1323
Mailing Address - Country:US
Mailing Address - Phone:845-987-4135
Mailing Address - Fax:
Practice Address - Street 1:401 HAMBURG TPKE STE 107
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2139
Practice Address - Country:US
Practice Address - Phone:973-706-0260
Practice Address - Fax:974-904-9119
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01326400363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty