Provider Demographics
NPI:1073626651
Name:GOODMAN, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2495 NEWBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-2231
Mailing Address - Country:US
Mailing Address - Phone:516-826-1200
Mailing Address - Fax:516-783-5689
Practice Address - Street 1:2495 NEWBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-2231
Practice Address - Country:US
Practice Address - Phone:516-826-1200
Practice Address - Fax:516-783-5689
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY130281207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
112588334OtherNIPPON
112588334OtherHUMANA
4226523OtherAETNA
68095OtherGHI HMO
AP639OtherOXFORD
MG03525510OtherBLUE CROSS
493272OtherAETNA
5148075OtherCIGNA
598199OtherUNITED HEALTH
0097809OtherGHI
112588334OtherHORIZON
3C9536OtherHEALTHNET
3C9536OtherHEALTHNET
C09047Medicare UPIN