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General NPI Number Information
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NPI Number | 1528718657
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Entity Type | Individual
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Provider Name | JUSTIN GOODFARB MD
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Gender | Male
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Dates
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Enumeration Date | 03/23/2022
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 1000 10TH AVE
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City | NEW YORK
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State | NY
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Zip | 10019-1147
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Country | US
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Telephone | 212-523-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 500 E 77TH ST APT 1637
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City | NEW YORK
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State | NY
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Zip | 10162-0033
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Country | US
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Telephone | 516-445-6982
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25MA12650000
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | NY
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