Provider Demographics
NPI:1306015532
Name:HAZEL GOODWIN MD
Entity Type:Organization
Organization Name:HAZEL GOODWIN MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEVELOPMENTAL BEHAVIORAL PEDIATRICS
Authorized Official - Prefix:
Authorized Official - First Name:HAZEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-272-6594
Mailing Address - Street 1:1979 ROCKAWAY PARKWAY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236
Mailing Address - Country:US
Mailing Address - Phone:718-272-6594
Mailing Address - Fax:718-701-4197
Practice Address - Street 1:1979 ROCKAWAY PARKWAY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236
Practice Address - Country:US
Practice Address - Phone:718-272-6594
Practice Address - Fax:718-701-4197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0896412080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01356472Medicaid
NYB7771Medicare UPIN
NYG2710Medicare PIN