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General NPI Number Information
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NPI Number | 1053030569
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Entity Type | Individual
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Provider Name | JAMES GERARD GOEHL III PA-C
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Gender | Male
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Dates
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Enumeration Date | 08/26/2022
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Last Update Date | 08/26/2022
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Provider Practice Location Address
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Address Line | 16 GUION PL
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City | NEW ROCHELLE
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State | NY
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Zip | 10801-5502
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Country | US
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Telephone | 914-632-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 3410 LORELEI DR
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City | YORKTOWN HEIGHTS
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State | NY
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Zip | 10598-2110
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Country | US
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Telephone | 914-403-2555
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 028759
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License Number State | NY
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