Provider Demographics
NPI:1073119707
Name:GOODROW, MARCIE (EDD)
Entity Type:Individual
Prefix:DR
First Name:MARCIE
Middle Name:
Last Name:GOODROW
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4235 STATE ROUTE 37
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-2803
Mailing Address - Country:US
Mailing Address - Phone:315-705-5511
Mailing Address - Fax:
Practice Address - Street 1:125 FINNEY BLVD
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953
Practice Address - Country:US
Practice Address - Phone:518-651-2302
Practice Address - Fax:518-483-2242
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty