MEDICARE: MR. BRIAN JAMES GOONAN PT, DPT

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	225100000X	Physical Therapist	02196201	NY

General Provider Information

NPI Number	:	1811036411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRIAN JAMES GOONAN PT, DPT

Provider Business Mailing Address
First Line	:	535 E 70TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10021-4898
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	584 BROADWAY RM 710
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10012-5242
Country	:	US
Telephone Number	:	212-941-0503
Fax Number	:

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

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	04/09/2021

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