Provider Demographics
NPI:1679934517
Name:GOLDBAUM-RATKEVICH, DREW K (NP-P, PMHNP)
Entity Type:Individual
Prefix:
First Name:DREW
Middle Name:K
Last Name:GOLDBAUM-RATKEVICH
Suffix:
Gender:F
Credentials:NP-P, PMHNP
Other - Prefix:
Other - First Name:DREW
Other - Middle Name:K
Other - Last Name:PHELAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:461 DEAN ST APT 16M
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-4148
Mailing Address - Country:US
Mailing Address - Phone:718-795-3727
Mailing Address - Fax:
Practice Address - Street 1:201 5TH AVE
Practice Address - Street 2:APT 2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-4481
Practice Address - Country:US
Practice Address - Phone:718-795-3727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-18
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY711470163WG0000X
NY403681363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice