MEDICARE: WARREN J GOODMAN D.P.M.

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	213EP1101X	Primary Podiatric Medicine Podiatrist	003926	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558373217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WARREN J GOODMAN D.P.M.

Provider Business Mailing Address
First Line	:	906 CRANFORD AVE
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11581-3114
Country	:	US
Telephone Number	:	516-791-5701
Fax Number	:

Provider Business Practice Location Address
First Line	:	83 MAIDEN LN FL 6
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10038-4812
Country	:	US
Telephone Number	:	212-780-2378
Fax Number	:

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

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	09/15/2010

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