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 1:529 LIDO BLVD
Mailing Address - Street 2:
Mailing Address - City:LIDO BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-5238
Mailing Address - Country:US
Mailing Address - Phone:516-889-0031
Mailing Address - Fax:
Practice Address - Street 1:529 LIDO BLVD
Practice Address - Street 2:
Practice Address - City:LIDO BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-5238
Practice Address - Country:US
Practice Address - Phone:516-889-0031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2024-07-08
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