Healthcare Provider Details

I. General information

NPI: 1235232513
Provider Name (Legal Business Name): AIMEE REBECCA GOODMAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 08/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300B PRINCETON HIGHTSTOWN RD SUITE 201
EAST WINDSOR NJ
08520-1400
US

IV. Provider business mailing address

881 OAKLEY DR
FREEHOLD NJ
07728-8240
US

V. Phone/Fax

Practice location:
  • Phone: 609-448-7300
  • Fax: 609-448-8022
Mailing address:
  • Phone: 732-841-2494
  • Fax: 732-780-3606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MB07997700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: