Provider Demographics
NPI:1912269697
Name:GRANADA-GOLDSTEIN, JANET
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:
Last Name:GRANADA-GOLDSTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:JANET
Other - Middle Name:
Other - Last Name:GRANADA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1918 MILLER PL
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-3417
Mailing Address - Country:US
Mailing Address - Phone:516-859-6382
Mailing Address - Fax:
Practice Address - Street 1:1918 MILLER PL
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3417
Practice Address - Country:US
Practice Address - Phone:516-859-6382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist