MEDICARE: DR. MATTHEW C GOULET 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	2084P0800X	Psychiatry Physician	172817	NY

General Provider Information

NPI Number	:	1841331550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW C GOULET M.D.

Provider Business Mailing Address
First Line	:	348 W 20TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10011-3302
Country	:	US
Telephone Number	:	212-529-8234
Fax Number	:	212-529-1301

Provider Business Practice Location Address
First Line	:	348 W 20TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10011-3302
Country	:	US
Telephone Number	:	212-529-8234
Fax Number	:	212-529-1301

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

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	07/08/2007

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