Healthcare Provider Details

I. General information

NPI: 1770728339
Provider Name (Legal Business Name): MAUREEN GOODMAN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2008
Last Update Date: 12/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSPECT AVE PSYCH DEPT
HACKENSACK NJ
07601-0000
US

IV. Provider business mailing address

30 PROSPECT AVE PSYCH DEPT
HACKENSACK NJ
07601-0000
US

V. Phone/Fax

Practice location:
  • Phone: 201-996-8393
  • Fax:
Mailing address:
  • Phone: 201-996-8393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number26NJ00167700
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: