Provider Demographics
NPI:1376743633
Name:JAMES J GOETZ
Entity Type:Organization
Organization Name:JAMES J GOETZ
Other - Org Name:JAMES J. GOETZ
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOETZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:631-586-3388
Mailing Address - Street 1:1428 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-1611
Mailing Address - Country:US
Mailing Address - Phone:631-586-3388
Mailing Address - Fax:631-586-3394
Practice Address - Street 1:1428 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-1611
Practice Address - Country:US
Practice Address - Phone:631-586-3388
Practice Address - Fax:631-586-3394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004737213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01236960Medicaid
NYP53381Medicare PIN
NYU18053Medicare UPIN
NY01236960Medicaid