NPIMap

Organization Active NPI

Healthy Aging Clinic

  • Adult Medicine Physician
  • Milford, DE
National Provider Identifier
1104171206
Registry record updated Jul 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
Legal business name
HEALTHY AGING CLINIC
Practice address
1014 North Walnut Street
Milford, DE 19963-1244
Phone
(302) 422-5700
Fax
(302) 424-8018
NPI assigned
Jul 16, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Eugene E. Godfrey, D.O.
Title
Physician
Phone
(302) 422-5700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207QA0505X Primary

Addresses

Primary practice location

1014 North Walnut Street
Milford, DE 19963-1244

Mailing address

1014 North Walnut Street
Milford, DE 19963-1244
Phone (302) 422-5700

National Provider Directory

National Provider Directory

Locations

1014 N Walnut St
Milford, DE 19963
Phone (302) 422-5700

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1342396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342396800000",
    "number": "1104171206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1014 NORTH WALNUT STREET",
            "city": "MILFORD",
            "state": "DE",
            "postal_code": "199631244",
            "telephone_number": "302-422-5700",
            "fax_number": "302-424-8018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1014 NORTH WALNUT STREET",
            "city": "MILFORD",
            "state": "DE",
            "postal_code": "199631244",
            "telephone_number": "302-422-5700",
            "fax_number": "302-424-8018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHY AGING CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-16",
        "last_updated": "2012-07-16",
        "status": "A",
        "authorized_official_last_name": "GODFREY",
        "authorized_official_first_name": "EUGENE",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "302-422-5700",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milford, DE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.