Provider Demographics
NPI:1922521145
Name:GORODN, BEVERLEY D (FNP)
Entity Type:Individual
Prefix:
First Name:BEVERLEY
Middle Name:D
Last Name:GORODN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3437 CORSA AVE APT 1B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-1929
Mailing Address - Country:US
Mailing Address - Phone:917-251-6346
Mailing Address - Fax:
Practice Address - Street 1:3437 CORSA AVE APT 1B
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-1929
Practice Address - Country:US
Practice Address - Phone:917-251-6346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-19
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339881363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily