Healthcare Provider Details

I. General information

NPI: 1366493272
Provider Name (Legal Business Name): DEBORAH GOODMAN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 06/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 W 42ND ST
NEW YORK NY
10036-8005
US

IV. Provider business mailing address

3 JODI CT
MONSEY NY
10952-1115
US

V. Phone/Fax

Practice location:
  • Phone: 212-938-4001
  • Fax: 212-938-5831
Mailing address:
  • Phone: 845-304-7542
  • Fax: 845-354-0208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberVUT004412
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: