Individual
JACK GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9 LIVINGSTON ST, STE 5, POUGHKEEPSIE, NY 12601
(845) 454-0415
(845) 454-0914
Mailing address
9 LIVINGSTON ST, STE 5, POUGHKEEPSIE, NY 12601
(845) 454-0415
(845) 454-0914
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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