Provider Demographics
NPI:1962657759
Name:GOODSON, JONATHAN (JONATHAN GOODSON)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:GOODSON
Suffix:
Gender:M
Credentials:JONATHAN GOODSON
Other - Prefix:DR
Other - First Name:JONATHAN
Other - Middle Name:
Other - Last Name:GOODSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6 IDLEWILD PARK DR
Mailing Address - Street 2:
Mailing Address - City:CORNWALL ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12520-1047
Mailing Address - Country:US
Mailing Address - Phone:845-534-2586
Mailing Address - Fax:845-534-2586
Practice Address - Street 1:6 IDLEWILD PARK DR
Practice Address - Street 2:
Practice Address - City:CORNWALL ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12520-1047
Practice Address - Country:US
Practice Address - Phone:845-534-2586
Practice Address - Fax:845-534-2586
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY108802208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology