1437555109 NPI number — MR. LARRY J GOISSE CRNP

Table of content: MR. LARRY J GOISSE CRNP (NPI 1437555109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437555109 NPI number — MR. LARRY J GOISSE CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOISSE
Provider First Name:
LARRY
Provider Middle Name:
J
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
M

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:
1437555109
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6425 LIVING PL
Provider Second Line Business Mailing Address:
SUITE 2085
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-274-0303
Provider Business Mailing Address Fax Number:
412-802-9156

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6425 LIVING PL
Provider Second Line Business Practice Location Address:
SUITE 2085
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-274-0303
Provider Business Practice Location Address Fax Number:
412-802-9156
Provider Enumeration Date:
11/07/2014

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: 363LP0808X , with the licence number:  RN577684 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: SP014433 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1245766310 . This is a "PRACTICE NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1437555109 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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