Provider Demographics
NPI:1427156686
Name:GOODMAN, MARIANNE (MD)
Entity type:Individual
Prefix:DR
First Name:MARIANNE
Middle Name:
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E 80TH ST
Mailing Address - Street 2:#5D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-0531
Mailing Address - Country:US
Mailing Address - Phone:212-734-3534
Mailing Address - Fax:212-249-4283
Practice Address - Street 1:215 E 80TH ST
Practice Address - Street 2:#5D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-0531
Practice Address - Country:US
Practice Address - Phone:212-734-3534
Practice Address - Fax:212-249-4283
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1248762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC11518Medicare UPIN
NY29F891Medicare ID - Type Unspecified