JENNA LYNN GOLDBACH (NPI# 1134616881) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134616881 |
| Entity Type | Individual |
| Full Name | JENNA LYNN GOLDBACH |
| Credential | FNP-C |
| Practice Address |
120 Mineola Blvd Ste 500 Mineola NY 11501-4074 |
| Mailing Address |
6417 80th St Middle Village NY 11379-2309 |
| Practice Telephone | 5166639500 |
| Mailing Telephone | 3472294951 |
| Enumeration Date | 2018-04-18 |
| Last Update Date | 2018-04-18 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | 673531-1 | NY | Nursing Service Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
F342757-1 | NY | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
120 MINEOLA BLVD STE 500 |
| City | MINEOLA |
| State | NY |
| Zip Code | 11501-4074 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609081561 | Julius Paul Duic | Emergency Medicine | 120 Mineola Blvd Ste 500, Mineola, NY 11501-4074 | 2007-05-14 |
| 1851937445 | Elsa Fikri Bahiru | Registered Nurse | 120 Mineola Blvd Ste 500, Mineola, NY 11501-4074 | 2019-11-19 |
| 1427691302 | Thaleshravi Prashad | Nurse Practitioner | 120 Mineola Blvd Ste 500, Mineola, NY 11501-4074 | 2019-10-23 |
| 1770026601 | Casey Chambers | Nurse Practitioner | 120 Mineola Blvd Ste 500, Mineola, NY 11501-4074 | 2016-11-25 |
| 1073990107 | Abhinav Rohatgi | Internal Medicine | 120 Mineola Blvd Ste 500, Mineola, NY 11501 | 2015-04-27 |
| 1568761336 | Marc Justin Braunstein | Internal Medicine | 120 Mineola Blvd Ste 500, Mineola, NY 11501-4074 | 2011-03-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710500350 | Steve Abraham Simon | Student in an Organized Health Care Education/Training Program | 222 Station Plaza, Suite 509, Mineola, NY 11501 | 2020-05-18 |
| 1407478167 | Frederick Milton Bosoy | Student in an Organized Health Care Education/Training Program | 259 1st St, Mineola, Ny 11501, Mineola, NY 11501 | 2020-05-15 |
| 1982226130 | Katelyn Anne Fowler | Counselor | [email protected], 410 East Jericho Tpke, Mineola, NY 11501 | 2020-05-11 |
| 1225667819 | New York Dialysis Services, Inc | Clinic/Center | 1 East Jericho Turnpike, Mineola, NY 11501 | 2020-04-06 |
| 1518500032 | Irina Victoria Kushnareva | Social Worker | 126 Saville Rd, Mineola, NY 11501 | 2019-10-28 |
| 1861046336 | Milagros M Matias | Case Manager/Care Coordinator | 39 E. Jericho Turnpike, Mineola, NY 11501 | 2019-08-01 |
| 1154974244 | Bahram Dabiri | Student in an Organized Health Care Education/Training Program | 222 Station Plaza N., Suite 620 Mineola, Mineola, NY 11501 | 2019-07-18 |
| 1972168748 | Nabeel A. Arain | Physician Assistant | 251 1st St., Mineola, NY 11501 | 2019-05-07 |
| 1598328940 | Ramsha Jabbar | Student in an Organized Health Care Education/Training Program | 222 Station Plaza North, Suite 305, Mineola, NY 11501 | 2019-04-20 |
| 1235628850 | Valentyna Erstenyuk | Student in an Organized Health Care Education/Training Program | 222 Station Plaza N, Suite 611, Mineola, NY 11501 | 2018-05-09 |
| Find all providers in zip 11501 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508334624 | Lisa Michele Campbell | Nurse Practitioner | 228 W Broad St, Mineola, TX 75773-2006 | 2018-11-06 |
| 1275022139 | Christina Josephine Megerian | Nurse Practitioner | 210 Old Country Rd, Mineola, NY 11501-4218 | 2018-05-07 |
| 1356880066 | Kaitlin J Duignan | Nurse Practitioner | 222 Station Plz N Ste 104, Mineola, NY 11501-3800 | 2017-02-14 |
| 1265583504 | Jill Quiambao | Nurse Practitioner | 1220 N Pacific St Ste 2, Mineola, TX 75773-1068 | 2007-01-15 |
| 1609976380 | Janice M. Morrell | Nurse Practitioner | 212 Mineola Blvd, Mineola, NY 11501 | 2006-09-23 |
| 1174139216 | Sneha Joseph | Nurse Practitioner | 137 Willis Ave, Mineola, NY 11501-2677 | 2020-09-22 |
| 1174136121 | Anatoliy Mirkin | Nurse Practitioner | 259 1st St, Mineola, NY 11501-3957 | 2020-08-28 |
| 1497368823 | Sajumon K Joseph | Nurse Practitioner | 259 1st St, Mineola, NY 11501-3957 | 2020-08-25 |
| 1164040143 | Melissa Dale Kersch | Nurse Practitioner | 259 1st St, Mineola, NY 11501-3957 | 2020-07-07 |
| 1427691302 | Thaleshravi Prashad | Nurse Practitioner | 120 Mineola Blvd Ste 500, Mineola, NY 11501-4074 | 2019-10-23 |
| Find all providers in MINEOLA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.