Provider Demographics
NPI:1093977993
Name:GOODGER, MICHELLE HAYNES (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:HAYNES
Last Name:GOODGER
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:9 BROOKSITE DR
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3400
Mailing Address - Country:US
Mailing Address - Phone:631-390-7800
Mailing Address - Fax:631-390-7821
Practice Address - Street 1:9 BROOKSITE DR
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3400
Practice Address - Country:US
Practice Address - Phone:631-390-7800
Practice Address - Fax:631-390-7821
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2019-06-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY253860207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease