Provider Demographics
NPI:1659301232
Name:GOODMAN, RICHARD EARL (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:EARL
Last Name:GOODMAN
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 1:340 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3213
Mailing Address - Country:US
Mailing Address - Phone:516-431-5064
Mailing Address - Fax:516-432-4516
Practice Address - Street 1:340 W PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3213
Practice Address - Country:US
Practice Address - Phone:516-431-5064
Practice Address - Fax:516-432-4516
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160030207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01136410Medicaid
NY01136410Medicaid
NYA60725Medicare UPIN