Provider Demographics
NPI:1124139142
Name:CENTRAL PARK WEST MEDICAL GROUP PC
Entity type:Organization
Organization Name:CENTRAL PARK WEST MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:R
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-769-4149
Mailing Address - Street 1:2 W 86TH ST
Mailing Address - Street 2:SUITE # 6
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3666
Mailing Address - Country:US
Mailing Address - Phone:212-769-4149
Mailing Address - Fax:212-769-0416
Practice Address - Street 1:2 W 86TH ST
Practice Address - Street 2:SUITE # 6
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3666
Practice Address - Country:US
Practice Address - Phone:212-769-4149
Practice Address - Fax:212-769-0416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWZYXQ1Medicare PIN