Provider Demographics
NPI:1053364075
Name:GOODMAN, CHRISTOPHER (PT)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W MAIN ST
Mailing Address - Street 2:SUITE 340
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-3012
Mailing Address - Country:US
Mailing Address - Phone:631-661-3180
Mailing Address - Fax:631-661-3183
Practice Address - Street 1:400 W MAIN ST
Practice Address - Street 2:SUITE 340
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3012
Practice Address - Country:US
Practice Address - Phone:631-661-3180
Practice Address - Fax:631-661-3183
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028198-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100099830OtherMEDICARE ID