Individual
JACK GOODMAN
Active
Individual
JACK GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
86055
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
147049
MVP
NY
01
—
C13377
RAILROAD MEDICARE
—
Enumeration date
09/06/2006
Last updated
09/04/2012
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