Provider Demographics
NPI:1982175410
Name:GOED, LORRAINE D
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:D
Last Name:GOED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5350 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-6703
Mailing Address - Country:US
Mailing Address - Phone:718-629-1000
Mailing Address - Fax:718-629-5252
Practice Address - Street 1:5350 KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203
Practice Address - Country:US
Practice Address - Phone:718-629-1000
Practice Address - Fax:718-629-5252
Is Sole Proprietor?:No
Enumeration Date:2018-12-10
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023005-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist