Provider Demographics
NPI:1942693718
Name:GOLDSMITH, JENNIFER (CPM)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:GOLDSMITH
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:RAIZY
Other - Middle Name:
Other - Last Name:GOLDSMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:575 SAGAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-2609
Mailing Address - Country:US
Mailing Address - Phone:973-725-9761
Mailing Address - Fax:
Practice Address - Street 1:575 SAGAMORE AVE
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-2609
Practice Address - Country:US
Practice Address - Phone:973-725-9761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MW00002200176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife