MEDICARE: JANE GOOTMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	047990-1	NY

General Provider Information

NPI Number	:	1528381902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE GOOTMAN

Provider Business Mailing Address
First Line	:	12 S MOUNTAIN PASS
Second Line	:
City	:	KATONAH
State	:	NY
Zip	:	10536-2634
Country	:	US
Telephone Number	:	917-690-0001
Fax Number	:

Provider Business Practice Location Address
First Line	:	422 CHURCH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-3108
Country	:	US
Telephone Number	:	718-686-2727
Fax Number	:	718-535-0855

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2010
Last Update Date	:	03/12/2010

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Directions to “ JANE GOOTMAN ” Practice Location

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