Healthcare Provider Details

I. General information

NPI: 1821031899
Provider Name (Legal Business Name): DAVID JAY GOODKIND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 12/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CHESTNUT STREET
BRANFORD CT
06405
US

IV. Provider business mailing address

2 CHESTNUT STREET
BRANFORD CT
06405
US

V. Phone/Fax

Practice location:
  • Phone: 203-871-3799
  • Fax: 203-646-9719
Mailing address:
  • Phone: 203-871-3799
  • Fax: 203-646-9719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number024179
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number024179
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number024179
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: