Provider Demographics
NPI:1033564117
Name:GOODMAN, SUZANNE (MSPT)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 WYCKOFF AVE
Mailing Address - Street 2:UNIT 364
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-1438
Mailing Address - Country:US
Mailing Address - Phone:973-798-6800
Mailing Address - Fax:973-798-6801
Practice Address - Street 1:19 ELM ST
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3451
Practice Address - Country:US
Practice Address - Phone:973-798-6800
Practice Address - Fax:973-798-6801
Is Sole Proprietor?:No
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA014179002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic