Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0402X | Child Neurologist | MA05933700 | NJ |
NPI | 1093807877 |
---|---|
Provider Name | Dr. Michael H Goodman |
First Address | Camden, NJ 08103-1088 |
Second Address | Camden, NJ 08103-1438 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 23/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G24828 | (02) | |
MA05933700 | STATE LICENSE (01) | NJ |