MEDICARE: DR. WILLIAM M. GOUMAS M.D.

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	208600000X	Surgery Physician	170446	NY
2	2086X0206X	Surgical Oncology Physician	170446	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
2	P01006368	OTHER	NY	MEDCIARE RR
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811991557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM M. GOUMAS M.D.

Provider Business Mailing Address
First Line	:	20 GRAND ST FL 3
Second Line	:	CREDENTIALING MANAGER
City	:	WARWICK
State	:	NY
Zip	:	10990-1035
Country	:	US
Telephone Number	:	845-987-3906
Fax Number	:	845-987-5979

Provider Business Practice Location Address
First Line	:	257 LAFAYETTE AVE
Second Line	:	SUITE 200
City	:	SUFFERN
State	:	NY
Zip	:	10901-4830
Country	:	US
Telephone Number	:	845-369-8800
Fax Number	:	845-357-0086

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

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	07/29/2015

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