Provider Demographics
NPI:1851591697
Name:GODAT, GERALDINE TALAMO
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:TALAMO
Last Name:GODAT
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 1:3411 93RD ST
Mailing Address - Street 2:APT. 2D
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-3750
Mailing Address - Country:US
Mailing Address - Phone:718-429-7409
Mailing Address - Fax:
Practice Address - Street 1:3411 93RD ST
Practice Address - Street 2:APT. 2D
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-3750
Practice Address - Country:US
Practice Address - Phone:718-429-7409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301179163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCR10299CMedicaid