Healthcare Provider Details

I. General information

NPI: 1346249844
Provider Name (Legal Business Name): DAVID H GODDARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 04/01/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 JORALEMON ST 8TH FLOOR
BROOKLYN NY
11201-4326
US

IV. Provider business mailing address

186 JORALEMON ST
BROOKLYN NY
11201-4326
US

V. Phone/Fax

Practice location:
  • Phone: 718-858-3263
  • Fax: 718-858-5095
Mailing address:
  • Phone: 718-858-3263
  • Fax: 718-858-5095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number185657
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: