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General NPI Number Information
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NPI Number | 1386277358
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Entity Type | Individual
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Provider Name | DONALD GOODALE LMT, LAC
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Gender | Male
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Dates
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Enumeration Date | 02/19/2020
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Last Update Date | 04/25/2022
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Provider Practice Location Address
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Address Line | 16 LYME LN
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City | EAST HAMPTON
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State | NY
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Zip | 11937-5162
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Country | US
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Telephone | 631-329-1677
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Fax |
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Provider Business Mailing Address
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Address Line | 16 LYME LN
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City | EAST HAMPTON
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State | NY
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Zip | 11937-5162
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Country | US
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Telephone |
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 006985-01
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 015593-01
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License Number State | NY
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