Healthcare Provider Details

I. General information

NPI: 1578958914
Provider Name (Legal Business Name): DEBBIE GOODMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 04/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 E 85TH ST
NEW YORK NY
10028-3001
US

IV. Provider business mailing address

1 GUSTAVE L LEVY PL # 3000
NEW YORK NY
10029-6504
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-6585
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number286802
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: