Provider Demographics
NPI:1144933953
Name:GOODWIN, JOSEFF MCKENNETH
Entity type:Individual
Prefix:
First Name:JOSEFF
Middle Name:MCKENNETH
Last Name:GOODWIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17931 EVELETH RD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-3407
Mailing Address - Country:US
Mailing Address - Phone:347-650-8199
Mailing Address - Fax:
Practice Address - Street 1:17931 EVELETH RD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-3407
Practice Address - Country:US
Practice Address - Phone:347-650-8199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty