Healthcare Provider Details

I. General information

NPI: 1609822923
Provider Name (Legal Business Name): JEFFREY HOWARD GOIDEL PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 HEMLOCK DR
CONGERS NY
10920-1401
US

IV. Provider business mailing address

7 WINDGATE DR
NEW CITY NY
10956-4434
US

V. Phone/Fax

Practice location:
  • Phone: 845-267-0110
  • Fax: 845-267-2634
Mailing address:
  • Phone: 845-638-0198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number008917
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: