Healthcare Provider Details

I. General information

NPI: 1427211366
Provider Name (Legal Business Name): HEIDI ERIKA GODOY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PATROON CREEK BLVD STE 211
ALBANY NY
12206-5012
US

IV. Provider business mailing address

449 ROUTE 146 STE 101
HALFMOON NY
12065-3239
US

V. Phone/Fax

Practice location:
  • Phone: 518-489-0044
  • Fax: 518-489-3591
Mailing address:
  • Phone: 518-373-3924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number60 249033
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: