=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689189532
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE MIDTOWN PRACTICE FOR PSYCHIATRY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2017
-----------------------------------------------------
Last Update Date | 12/27/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18 E 48TH ST RM 1202
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10017-1038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-286-8801
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18 E 48TH ST RM 1202
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10017-1038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-286-8801
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DANIEL GOODMAN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 212-286-8801
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 216317
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 186122
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------