Provider Demographics
NPI:1235154303
Name:GOODMAN, KARL RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:RICHARD
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2 W 86TH ST
Mailing Address - Street 2:SUITE # 6
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3666
Mailing Address - Country:US
Mailing Address - Phone:212-769-4149
Mailing Address - Fax:212-769-0416
Practice Address - Street 1:2 W 86TH ST
Practice Address - Street 2:SUITE # 6
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3666
Practice Address - Country:US
Practice Address - Phone:212-769-4149
Practice Address - Fax:212-769-0416
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY89D241Medicare ID - Type Unspecified
NY89D24ZYXQ1Medicare PIN
NYA64665Medicare UPIN