Provider Demographics
NPI:1770515488
Name:GOEZ, JUAN C (DPM)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:C
Last Name:GOEZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 W MERRICK RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-3374
Mailing Address - Country:US
Mailing Address - Phone:516-378-8383
Mailing Address - Fax:516-377-6991
Practice Address - Street 1:294 W MERRICK RD
Practice Address - Street 2:SUITE 8
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3374
Practice Address - Country:US
Practice Address - Phone:516-378-8383
Practice Address - Fax:516-377-6991
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004890213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01810695Medicaid
P55691Medicare ID - Type Unspecified
U28883Medicare UPIN