Provider Demographics
NPI:1508847013
Name:GOODMAN, JENNIFER LYNN (DPM)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:6701 ROCKSIDE RD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2358
Mailing Address - Country:US
Mailing Address - Phone:216-520-0033
Mailing Address - Fax:216-707-3729
Practice Address - Street 1:6701 ROCKSIDE RD
Practice Address - Street 2:SUITE 340
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2358
Practice Address - Country:US
Practice Address - Phone:216-520-0033
Practice Address - Fax:216-707-3729
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH36003353213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2590398Medicaid
GO4236261Medicare PIN
OHV05325Medicare UPIN
OH2590398Medicaid