Provider Demographics
NPI:1730449505
Name:GOODMAN, DENISE E (NP-C)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:E
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 GREENVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-2608
Mailing Address - Country:US
Mailing Address - Phone:201-333-8222
Mailing Address - Fax:201-333-0095
Practice Address - Street 1:510 31ST ST BSMT
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-3907
Practice Address - Country:US
Practice Address - Phone:201-866-3322
Practice Address - Fax:201-866-2289
Is Sole Proprietor?:No
Enumeration Date:2012-05-25
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00342900363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0595616Medicaid