Goodman, Glen K
Goodman, Glen K is an individual health care provider with primary practice located at 87 Grandview Ave , Waterbury CT 06708-2514. He recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as his primary health care specialty. Goodman, Glen K can be contacted via phone (203) 574-2020.Contact Information
Primary practice address
87 Grandview Ave
Waterbury CT 06708-2514
Phone: (203) 574-2020
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Ophthalmology | 207W00000X | 46944 | Massachusetts |
| Allopathic & Osteopathic Physicians / Ophthalmology | 207W00000X | 67111 | Connecticut |
Profile Details
| NPI number | 1043218159 |
|---|---|
| LBN Legal business name | Goodman, Glen K |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 12th, 2005 |
| Last updated | Nov 3rd, 2021 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1043218159 | NPPES |
| Massachusetts | MEDICAID | 0177555 |
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