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General NPI Number Information
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NPI Number | 1164654729
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Entity Type | Organization
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Legal Business Name | JACK GOODMAN, M.D. PC
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Dates
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Enumeration Date | 08/17/2009
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Last Update Date | 08/17/2009
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Provider Practice Location Address
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Address Line | 9 LIVINGSTON ST SUITE 9
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City | POUGHKEEPSIE
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State | NY
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Zip | 12601-4719
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Country | US
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Telephone | 845-454-0415
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Fax | 845-454-0914
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Provider Business Mailing Address
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Address Line | 9 LIVINGSTON ST SUITE 9
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City | POUGHKEEPSIE
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State | NY
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Zip | 12601-4719
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Country | US
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Telephone | 845-454-0415
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Fax | 845-454-0914
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Authorized Official
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Title or Position | OWNER
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Name | DR. JACK GOODMAN
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Credential | MD
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Telephone | 845-454-0415
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 086055
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License Number State | NY
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