Individual
AUDREY BLAINE GODNICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
59 COLONY LN, ROSLYN HEIGHTS, NY 11577-2218
(516) 578-3796
(516) 621-1259
Mailing address
59 COLONY LN, ROSLYN HEIGHTS, NY 11577-2218
(516) 578-3796
(516) 621-1259
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
324716526
DRIVERS LICENSE
FL
Enumeration date
01/14/2020
Last updated
01/14/2020
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