Provider Demographics
NPI:1740855592
Name:GOTTDIENER, FREDERICA (RN)
Entity type:Individual
Prefix:MRS
First Name:FREDERICA
Middle Name:
Last Name:GOTTDIENER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:FREIDY
Other - Middle Name:
Other - Last Name:GOTTDIENER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:1064 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-4266
Mailing Address - Country:US
Mailing Address - Phone:917-859-6366
Mailing Address - Fax:
Practice Address - Street 1:1520 E 13TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-7106
Practice Address - Country:US
Practice Address - Phone:718-382-1060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-24
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY778055-01163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WS0200XNursing Service ProvidersRegistered NurseSchoolGroup - Single Specialty