Provider Demographics
NPI:1629274865
Name:GOODMAN, ARLENE MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:ARLENE
Middle Name:MICHELLE
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:562 EASTON AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1900
Mailing Address - Country:US
Mailing Address - Phone:732-565-5455
Mailing Address - Fax:732-565-5454
Practice Address - Street 1:562 EASTON AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1900
Practice Address - Country:US
Practice Address - Phone:732-565-5455
Practice Address - Fax:732-565-5454
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2014-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4351982080S0010X
NJ25MA084675002080S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080S0010XAllopathic & Osteopathic PhysiciansPediatricsSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102204808-0001Medicaid
PA802043J5NMedicare UPIN