Provider Demographics
NPI:1528220084
Name:GODOY, JOHANNA FRANCESCA (DPM)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:FRANCESCA
Last Name:GODOY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 ALPS ROAD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3904
Mailing Address - Country:US
Mailing Address - Phone:973-768-8425
Mailing Address - Fax:
Practice Address - Street 1:53RD AVE EAST 124RTH STREET
Practice Address - Street 2:
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10035-1896
Practice Address - Country:US
Practice Address - Phone:212-410-8145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006279-1213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery