Provider Demographics
NPI:1801041827
Name:MERY GOODEN DPM P.C.
Entity Type:Organization
Organization Name:MERY GOODEN DPM P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MERY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-259-6666
Mailing Address - Street 1:209 AVENUE P
Mailing Address - Street 2:AVENUE P MEDICAL OFFICE
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204
Mailing Address - Country:US
Mailing Address - Phone:718-259-6666
Mailing Address - Fax:718-259-7000
Practice Address - Street 1:209 AVENUE P
Practice Address - Street 2:AVENUE P MEDICAL OFFICE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204
Practice Address - Country:US
Practice Address - Phone:718-259-6666
Practice Address - Fax:718-259-7000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006235213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty