Provider Demographics
NPI:1689706004
Name:GOODMAN, WENDY MARIE (DC,)
Entity type:Individual
Prefix:DR
First Name:WENDY
Middle Name:MARIE
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:DC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1789 STATE ROUTE 96A
Mailing Address - Street 2:
Mailing Address - City:OVID
Mailing Address - State:NY
Mailing Address - Zip Code:14521-9712
Mailing Address - Country:US
Mailing Address - Phone:607-869-5311
Mailing Address - Fax:
Practice Address - Street 1:751 PRE EMPTION RD
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-1335
Practice Address - Country:US
Practice Address - Phone:315-789-2606
Practice Address - Fax:315-781-3288
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009587-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVO5467Medicare UPIN
NYRA7128Medicare ID - Type Unspecified