Provider Demographics
NPI:1356303259
Name:GOODWIN, AIMEE TERESE (RPA-C)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:TERESE
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 HEMPSTEAD TPKE
Mailing Address - Street 2:STE 102
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-2028
Mailing Address - Country:US
Mailing Address - Phone:516-605-1955
Mailing Address - Fax:516-605-1956
Practice Address - Street 1:4900 HEMPSTEAD TPKE
Practice Address - Street 2:STE 102
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-2028
Practice Address - Country:US
Practice Address - Phone:516-605-1955
Practice Address - Fax:516-605-1956
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006601363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00286200OtherRAILROAD MEDICARE
NY5401LEZ521Medicare PIN
Q16830Medicare UPIN