Provider Demographics
NPI:1750578639
Name:GOOD, NECOLE RENEE (PT)
Entity type:Individual
Prefix:MRS
First Name:NECOLE
Middle Name:RENEE
Last Name:GOOD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 JEFFERSON HTS
Mailing Address - Street 2:
Mailing Address - City:CATSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12414-1215
Mailing Address - Country:US
Mailing Address - Phone:519-943-5151
Mailing Address - Fax:518-943-9107
Practice Address - Street 1:154 JEFFERSON HTS
Practice Address - Street 2:
Practice Address - City:CATSKILL
Practice Address - State:NY
Practice Address - Zip Code:12414-1215
Practice Address - Country:US
Practice Address - Phone:519-943-5151
Practice Address - Fax:518-943-9107
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021526-1314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility