Provider Demographics
NPI:1063116598
Name:GODEK, DAKOTA
Entity type:Individual
Prefix:MR
First Name:DAKOTA
Middle Name:
Last Name:GODEK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 VETERANS MEMORIAL HWY STE 10
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-4300
Mailing Address - Country:US
Mailing Address - Phone:631-776-3019
Mailing Address - Fax:
Practice Address - Street 1:340 VETERANS MEMORIAL HWY STE 10
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-4300
Practice Address - Country:US
Practice Address - Phone:631-776-3019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist