Active NPI
Kenneth Goodman, M.D.
- Anesthesiology Physician
- Manhasset, NY
National Provider Identifier
1730382714
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 157166-1
- Practice address
- 1615 Northern Blvd
Manhasset, NY 11030 - Phone
- (718) 217-2896
- Fax
- (718) 217-4471
- NPI assigned
- Jun 7, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 157166-1 | NY | Primary |
Addresses
Primary practice location
1615 Northern Blvd
Manhasset, NY 11030
Mailing address
345 Birdsall Drive
Yorktown Heights, NY 10598
Phone (718) 217-2896
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jun 24, 2018 through Jun 24, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 157166-1 | NY | MD | Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181174400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1730382714",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "345 BIRDSALL DRIVE",
"city": "YORKTOWN HEIGHTS",
"state": "NY",
"postal_code": "10598",
"telephone_number": "718-217-2896",
"fax_number": "718-217-4471"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1615 NORTHERN BLVD",
"city": "MANHASSET",
"state": "NY",
"postal_code": "11030",
"telephone_number": "718-217-2896",
"fax_number": "718-217-4471"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOODMAN",
"first_name": "KENNETH",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-06-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "NY",
"license": "157166-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manhasset, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.