Provider Demographics
NPI:1912901679
Name:GODEC, CIRIL J (MD)
Entity Type:Individual
Prefix:DR
First Name:CIRIL
Middle Name:J
Last Name:GODEC
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:339 HICKS ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5509
Mailing Address - Country:US
Mailing Address - Phone:516-569-0696
Mailing Address - Fax:516-569-3677
Practice Address - Street 1:339 HICKS ST
Practice Address - Street 2:FL 7
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5509
Practice Address - Country:US
Practice Address - Phone:718-780-1520
Practice Address - Fax:718-780-4703
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2007-09-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY154270-1208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00789937Medicaid
NY00789937Medicaid
NY97A611Medicare PIN