Healthcare Provider Details

I. General information

NPI: 1528220084
Provider Name (Legal Business Name): JOHANNA FRANCESCA GODOY DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

468 PARISH DR STE 4
WAYNE NJ
07470-4671
US

IV. Provider business mailing address

PO BOX 95000
PHILADELPHIA PA
19195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 212-410-8145
  • Fax:
Mailing address:
  • Phone: 844-362-1735
  • Fax: 973-290-7495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN006279-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: