Individual
THALIA GOODEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CM
Contact information
Practice address
70 MAPLE AVE, SMITHTOWN, NY 11787-3502
(631) 361-7526
Mailing address
683 IVY PL, UNIONDALE, NY 11553-2920
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
F001882
NY
367A00000X
Advanced Practice Midwife
—
—
Other
Enumeration date
09/10/2018
Last updated
10/03/2019
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