Provider Demographics
NPI:1053414318
Name:GOODMAN, ALLEN I (MD)
Entity type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:
Last Name:GOODMAN
Suffix:I
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 1:212 CANAL STREET, SUITE 206
Mailing Address - Street 2:CANAL RADIOLOGY
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013
Mailing Address - Country:US
Mailing Address - Phone:732-598-3310
Mailing Address - Fax:212-349-2760
Practice Address - Street 1:212 CANAL STREET
Practice Address - Street 2:SUITE 206
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013
Practice Address - Country:US
Practice Address - Phone:732-598-3310
Practice Address - Fax:212-349-2760
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156910174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1520598OtherAETNA HMO
NY0144794OtherGHI
NYANC835OtherOCFORD
NY059XH1OtherEMPIRE BCBS
NY4465156OtherAETNA PPO
NY00976430Medicaid
NY00976430Medicaid
NY0144794OtherGHI
NY47F852Medicare PIN
NYANC835OtherOCFORD
NY059XH1OtherEMPIRE BCBS