Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter | CPED1770 | NY |
NPI | 1932670130 |
---|---|
Provider Name | Jaime Goodman |
First Address | Voorheesville, NY 12186-5042 |
Second Address | Albany, NY 12205-4050 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2018 |
Last Update Date | 16/12/2018 |