MEDICARE: MR. ANTHONY GOEZ DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	213ES0103X	Foot & Ankle Surgery Podiatrist	N007299	NY

General Provider Information

NPI Number	:	1629651542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANTHONY GOEZ DPM

Provider Business Mailing Address
First Line	:	294 W MERRICK RD STE 8
Second Line	:
City	:	FREEPORT
State	:	NY
Zip	:	11520-3357
Country	:	US
Telephone Number	:	516-378-8383
Fax Number	:

Provider Business Practice Location Address
First Line	:	294 W MERRICK RD STE 8
Second Line	:
City	:	FREEPORT
State	:	NY
Zip	:	11520-3357
Country	:	US
Telephone Number	:	516-378-8383
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2021
Last Update Date	:	08/06/2024

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