1366061376 NPI number — CHRISTINE GO NP IN FAMILY HEALTH PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366061376 NPI number — CHRISTINE GO NP IN FAMILY HEALTH PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTINE GO NP IN FAMILY HEALTH PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366061376
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
434 S MARGINAL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JERICHO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11753-1914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-919-9339
Provider Business Mailing Address Fax Number:
866-886-6638

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 MADISON AVE STE 1200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10017-5441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-500-0126
Provider Business Practice Location Address Fax Number:
866-886-6638
Provider Enumeration Date:
04/09/2020

Additional Information

Authorized Official

Authorized Official Last Name:
GO
Authorized Official First Name:
CHRISTINE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
646-919-9339

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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