Provider Demographics
NPI:1013301027
Name:GOLDSTEIN, BAILA S (RN)
Entity Type:Individual
Prefix:
First Name:BAILA
Middle Name:S
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2922
Mailing Address - Country:US
Mailing Address - Phone:516-724-0106
Mailing Address - Fax:
Practice Address - Street 1:350 FOREST AVE
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-2922
Practice Address - Country:US
Practice Address - Phone:516-724-0106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-27
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY682394163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse