Provider Demographics
NPI:1811991557
Name:GOUMAS, WILLIAM M (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:M
Last Name:GOUMAS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:20 GRAND ST FL 3
Mailing Address - Street 2:CREDENTIALING MANAGER
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1035
Mailing Address - Country:US
Mailing Address - Phone:845-987-3906
Mailing Address - Fax:845-987-5979
Practice Address - Street 1:257 LAFAYETTE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4830
Practice Address - Country:US
Practice Address - Phone:845-369-8800
Practice Address - Fax:845-357-0086
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2015-07-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY170446208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0257010Medicaid
NYP01006368OtherMEDCIARE RR
NY02812531Medicaid
SDE02441Medicare UPIN
NJ0257010Medicaid
SD9169797OtherDAKOTACARE