Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 003926 | NY |
NPI | 1558373217 |
---|---|
Provider Name | Warren J Goodman |
First Address | Valley Stream, NY 11581-3114 |
Second Address | New York, NY 10038-4812 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2006 |
Last Update Date | 15/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00904201 | (05) | NY |