Provider Demographics
NPI:1720223613
Name:GOOCH, HOWARD
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:
Last Name:GOOCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179TH STREET AND LINDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:ST.ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11425
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:179TH STREET AND LINDEN BLVD
Practice Address - Street 2:
Practice Address - City:ST.ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11425
Practice Address - Country:US
Practice Address - Phone:718-298-8590
Practice Address - Fax:718-298-8669
Is Sole Proprietor?:No
Enumeration Date:2008-12-08
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter