Provider Demographics
NPI:1356170948
Name:GOOSE STAFF MEDICAL LLC
Entity type:Organization
Organization Name:GOOSE STAFF MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MALINAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-789-9578
Mailing Address - Street 1:839 EMPIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-5653
Mailing Address - Country:US
Mailing Address - Phone:347-789-9578
Mailing Address - Fax:718-498-7927
Practice Address - Street 1:839 EMPIRE BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-5653
Practice Address - Country:US
Practice Address - Phone:347-789-9578
Practice Address - Fax:718-498-7927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy