Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 042587 | NY |
NPI | 1023218732 |
---|---|
Provider Name | Dr. Adam Goodman |
First Address | New York, NY 10022-3045 |
Second Address | New York, NY 10022-3045 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2007 |
Last Update Date | 20/07/2007 |