Provider Demographics
NPI:1295799732
Name:GOODMAN, DANIEL WINTNER (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:WINTNER
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 1:9 GLEN AVON DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CT
Mailing Address - Zip Code:06878-2006
Mailing Address - Country:US
Mailing Address - Phone:203-698-2769
Mailing Address - Fax:212-717-7197
Practice Address - Street 1:18 E 48TH ST RM 1202
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-1038
Practice Address - Country:US
Practice Address - Phone:212-980-5600
Practice Address - Fax:212-682-9008
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0422142084P0800X
NY1861222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
66H761Medicare ID - Type Unspecified
F5844Medicare UPIN