Healthcare Provider Details

I. General information

NPI: 1326048224
Provider Name (Legal Business Name): GODDARD S LAINJO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date: 03/21/2006
Reactivation Date: 03/31/2006

III. Provider practice location address

41 DOLSON AVE
MIDDLETOWN NY
10940-6489
US

IV. Provider business mailing address

41 DOLSON AVE
MIDDLETOWN NY
10940-6489
US

V. Phone/Fax

Practice location:
  • Phone: 845-342-4655
  • Fax: 845-342-6850
Mailing address:
  • Phone: 845-342-4655
  • Fax: 845-342-6850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number147716
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: