Provider Demographics
NPI:1609822923
Name:GOIDEL, JEFFREY HOWARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:HOWARD
Last Name:GOIDEL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 WINDGATE DR
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-4434
Mailing Address - Country:US
Mailing Address - Phone:845-638-0198
Mailing Address - Fax:
Practice Address - Street 1:25 HEMLOCK DR
Practice Address - Street 2:
Practice Address - City:CONGERS
Practice Address - State:NY
Practice Address - Zip Code:10920-1401
Practice Address - Country:US
Practice Address - Phone:845-267-0110
Practice Address - Fax:845-267-2634
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008917103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV69821Medicare ID - Type Unspecified