Healthcare Provider Details

I. General information

NPI: 1023218732
Provider Name (Legal Business Name): ADAM GOODMAN D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 E 57TH ST SUITE 1A
NEW YORK NY
10022-3045
US

IV. Provider business mailing address

440 E 57TH ST SUITE 1A
NEW YORK NY
10022-3045
US

V. Phone/Fax

Practice location:
  • Phone: 212-688-4663
  • Fax: 212-688-1270
Mailing address:
  • Phone: 212-688-4663
  • Fax: 212-688-1270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number042587
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: