Provider Demographics
NPI:1598721912
Name:GOODHEART, HERBERT PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:PAUL
Last Name:GOODHEART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:969 MAIN ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-1789
Mailing Address - Country:US
Mailing Address - Phone:845-896-7730
Mailing Address - Fax:845-896-7758
Practice Address - Street 1:969 MAIN ST
Practice Address - Street 2:SUITE D
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-1789
Practice Address - Country:US
Practice Address - Phone:845-896-7730
Practice Address - Fax:845-896-7758
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYA 116071-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
B18948Medicare UPIN
NY713511 GRP. W23631Medicare ID - Type Unspecified