Provider Demographics
NPI:1407410277
Name:GOODING, YAKEMA R (LMT)
Entity Type:Individual
Prefix:
First Name:YAKEMA
Middle Name:R
Last Name:GOODING
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 ELMWOOD PL APT 2B
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-3203
Mailing Address - Country:US
Mailing Address - Phone:908-414-8591
Mailing Address - Fax:
Practice Address - Street 1:35 ELMWOOD PL APT 2B
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-3203
Practice Address - Country:US
Practice Address - Phone:908-414-8591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-27
Last Update Date:2019-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT01061400225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist