Provider Demographics
NPI:1770702862
Name:GODDARD LAINJO, M.D., P.C.
Entity type:Organization
Organization Name:GODDARD LAINJO, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GODDARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:LAINJO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-342-4655
Mailing Address - Street 1:41 DOLSON AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-6489
Mailing Address - Country:US
Mailing Address - Phone:845-342-4655
Mailing Address - Fax:845-342-6850
Practice Address - Street 1:41 DOLSON AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-6489
Practice Address - Country:US
Practice Address - Phone:845-342-4655
Practice Address - Fax:845-342-6850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2008-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147716207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA99198Medicare UPIN