Provider Demographics
NPI:1831916741
Name:GOEZ, MARY ELIZABETH
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:GOEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:292 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-5414
Mailing Address - Country:US
Mailing Address - Phone:516-287-0754
Mailing Address - Fax:
Practice Address - Street 1:2001 MARCUS AVE STE W290
Practice Address - Street 2:
Practice Address - City:NORTH NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1098
Practice Address - Country:US
Practice Address - Phone:516-465-5255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY354395363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily