Provider Demographics
NPI:1457651796
Name:MICHAEL GOODMAN M.D., P.C.
Entity Type:Organization
Organization Name:MICHAEL GOODMAN M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-826-1200
Mailing Address - Street 1:2495 NEWBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-2231
Mailing Address - Country:US
Mailing Address - Phone:516-826-1200
Mailing Address - Fax:516-783-5689
Practice Address - Street 1:2495 NEWBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-2231
Practice Address - Country:US
Practice Address - Phone:516-826-1200
Practice Address - Fax:516-783-5689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC09047Medicare UPIN