Provider Demographics
NPI:1447255351
Name:GOODMAN, ALAN JAY (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:JAY
Last Name:GOODMAN
Suffix:
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 1:525 E 86TH ST APT 8C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-7514
Mailing Address - Country:US
Mailing Address - Phone:973-283-5864
Mailing Address - Fax:888-873-3987
Practice Address - Street 1:525 E 86TH ST APT 8C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-7514
Practice Address - Country:US
Practice Address - Phone:973-283-5864
Practice Address - Fax:888-873-3987
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY165206207RA0201X, 207K00000X
NJ25MA5282400207RA0201X
NJMA52824207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A62343Medicare UPIN