Provider Demographics
NPI:1013331867
Name:GOTHAM PER DIEM
Entity Type:Organization
Organization Name:GOTHAM PER DIEM
Other - Org Name:GOTHAM PER DIEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHATAERA
Authorized Official - Middle Name:
Authorized Official - Last Name:SINCLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:347-228-8786
Mailing Address - Street 1:420 COLUMBIA ST APT 5B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-2070
Mailing Address - Country:US
Mailing Address - Phone:347-228-8786
Mailing Address - Fax:347-763-0112
Practice Address - Street 1:420 COLUMBIA ST APT 5B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-2070
Practice Address - Country:US
Practice Address - Phone:347-228-8786
Practice Address - Fax:347-763-0112
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOTHAM PER DIEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-14
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY676183-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health