Provider Demographics
NPI:1427014810
Name:GOODMAN, MARK A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:975 STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4816
Mailing Address - Country:US
Mailing Address - Phone:516-222-8610
Mailing Address - Fax:516-745-5476
Practice Address - Street 1:975 STEWART AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4816
Practice Address - Country:US
Practice Address - Phone:516-222-8610
Practice Address - Fax:516-745-5476
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101625207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00439107Medicaid
NY00439107Medicaid
NYC11923Medicare UPIN