Provider Demographics
NPI:1356041123
Name:GOODMAN, JOSHUA SCACCIA (PA)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:SCACCIA
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5989 BIG TREE RD STE A
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14480-9719
Mailing Address - Country:US
Mailing Address - Phone:585-346-4460
Mailing Address - Fax:
Practice Address - Street 1:5989 BIG TREE RD STE A
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:NY
Practice Address - Zip Code:14480-9719
Practice Address - Country:US
Practice Address - Phone:585-346-4460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2025-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029399363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical