Provider Demographics
NPI:1063595528
Name:GOODMAN, WARREN HARVEY (MD)
Entity type:Individual
Prefix:DR
First Name:WARREN
Middle Name:HARVEY
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BARSTOW ROAD
Mailing Address - Street 2:SUITE P 14
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3501
Mailing Address - Country:US
Mailing Address - Phone:516-487-1484
Mailing Address - Fax:516-487-7804
Practice Address - Street 1:1 BARSTOW ROAD
Practice Address - Street 2:SUITE P 14
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-3501
Practice Address - Country:US
Practice Address - Phone:516-487-1484
Practice Address - Fax:516-487-7804
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0842202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY506211Medicaid
NY506211Medicare ID - Type Unspecified
NY506211Medicaid