Provider Demographics
NPI:1881947307
Name:MORRIS GOODMAN PH.D. P.A.
Entity type:Organization
Organization Name:MORRIS GOODMAN PH.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MORRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:973-758-0454
Mailing Address - Street 1:5 HASTINGS LN
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-5109
Mailing Address - Country:US
Mailing Address - Phone:973-375-8045
Mailing Address - Fax:973-992-7260
Practice Address - Street 1:5 HASTINGS LN
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5109
Practice Address - Country:US
Practice Address - Phone:973-758-0454
Practice Address - Fax:973-992-7260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100001800251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ604922Medicare PIN