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General NPI Number Information
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NPI Number | 1124139142
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Entity Type | Organization
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Legal Business Name | CENTRAL PARK WEST MEDICAL GROUP PC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 02/13/2008
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Provider Practice Location Address
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Address Line | 2 W 86TH ST SUITE # 6
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City | NEW YORK
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State | NY
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Zip | 10024-3666
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Country | US
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Telephone | 212-769-4149
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Fax | 212-769-0416
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Provider Business Mailing Address
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Address Line | 2 W 86TH ST SUITE # 6
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City | NEW YORK
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State | NY
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Zip | 10024-3666
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Country | US
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Telephone | 212-769-4149
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Fax | 212-769-0416
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KARL R GOODMAN
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Credential | MD
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Telephone | 212-769-4149
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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