Healthcare Provider Details

I. General information

NPI: 1073997623
Provider Name (Legal Business Name): GOSHEN PEDIATRICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 11/17/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 ROUTE 17M SUITE 8
GOSHEN NY
10924
US

IV. Provider business mailing address

2002 ROUTE 17M SUITE 8
GOSHEN NY
10924
US

V. Phone/Fax

Practice location:
  • Phone: 845-291-7059
  • Fax: 845-291-0905
Mailing address:
  • Phone: 845-291-7059
  • Fax: 845-291-0905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number189547
License Number StateNY

VIII. Authorized Official

Name: DR. JAMES N WAPSHARE
Title or Position: OWNER
Credential: MD
Phone: 845-291-7059