1982784609 NPI number — MICHAEL S. GOODMAN, DDS, PC

Table of content: (NPI 1982784609)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982784609 NPI number — MICHAEL S. GOODMAN, DDS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL S. GOODMAN, DDS, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982784609
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
85-15 67TH ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REGO PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11374
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-583-4545
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
245 EAST 50TH STREET
Provider Second Line Business Practice Location Address:
C/O ELK DENTAL ASSOCIATES
Provider Business Practice Location Address City Name:
NYC
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-593-1212
Provider Business Practice Location Address Fax Number:
212-832-3014
Provider Enumeration Date:
10/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GOODMAN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
212-593-1212

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DDS030169 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 030169 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)