1992896260 NPI number — DR. ROBERT JOSEPH GOEBEL D.C.

Table of content: (NPI 1902861602)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992896260 NPI number — DR. ROBERT JOSEPH GOEBEL D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOEBEL
Provider First Name:
ROBERT
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

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:
1992896260
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
123 FULTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARDEN CITY PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11040-5305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-248-3647
Provider Business Mailing Address Fax Number:
516-248-1347

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
123 FULTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARDEN CITY PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11040-5305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-248-3647
Provider Business Practice Location Address Fax Number:
516-248-1347
Provider Enumeration Date:
09/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  X002957-1 , 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)

  • Identifier: 1C8413 . This is a "PHS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: T52418 . This is a "BC BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0576521 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0068203 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 324209 . This is a "A.C.N." identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 37710P . This is a "PRISM" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1C4355 . This is a "PHS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1C8413 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 49447 . This is a "VYTRA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6086122 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: C02957-1 . This is a "WORKERS COMP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: D07745 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: MPIN-40735 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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