Provider Demographics
NPI:1811151921
Name:GOODMAN, BARRY JAY (DC)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:JAY
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 LONG BEACH RD
Mailing Address - Street 2:
Mailing Address - City:ISLAND PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11558-1512
Mailing Address - Country:US
Mailing Address - Phone:516-889-4280
Mailing Address - Fax:516-431-3757
Practice Address - Street 1:156 LONG BEACH RD
Practice Address - Street 2:
Practice Address - City:ISLAND PARK
Practice Address - State:NY
Practice Address - Zip Code:11558-1512
Practice Address - Country:US
Practice Address - Phone:516-889-4280
Practice Address - Fax:516-431-3757
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5343111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX1C231Medicare PIN