Healthcare Provider Details

I. General information

NPI: 1295799732
Provider Name (Legal Business Name): DANIEL WINTNER GOODMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 E 48TH ST RM 1202
NEW YORK NY
10017-1038
US

IV. Provider business mailing address

9 GLEN AVON DR
RIVERSIDE CT
06878-2006
US

V. Phone/Fax

Practice location:
  • Phone: 212-980-5600
  • Fax: 212-682-9008
Mailing address:
  • Phone: 203-698-2769
  • Fax: 212-717-7197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number042214
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number186122
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: