1902888001 NPI number — DR. JENNIFER HOPE GOLDWASSER M.D.

Table of content: DR. JENNIFER HOPE GOLDWASSER M.D. (NPI 1902888001)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902888001 NPI number — DR. JENNIFER HOPE GOLDWASSER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOLDWASSER
Provider First Name:
JENNIFER
Provider Middle Name:
HOPE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1902888001
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 N CENTRAL AVE
Provider Second Line Business Mailing Address:
STE 320
Provider Business Mailing Address City Name:
HARTSDALE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10530-1951
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-422-3376
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 LANDING DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOBBS FERRY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10522-1184
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-715-8678
Provider Business Practice Location Address Fax Number:
914-259-5432
Provider Enumeration Date:
11/16/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  184329 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01477581 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".