Individual
BRUCE S GOODMAN I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BOCP
Contact information
Practice address
280 MIDDLE COUNTRY RD STE G, SELDEN, NY 11784-2532
(631) 732-5556
(631) 732-0218
Mailing address
280 MIDDLE COUNTRY RD STE G, SELDEN, NY 11784-2532
(631) 732-5556
(631) 732-0218
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00615045
—
NY
Enumeration date
11/11/2020
Last updated
11/11/2020
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