Provider Demographics
NPI:1861613929
Name:GODOY, WIGBERT SAUL (MD)
Entity type:Individual
Prefix:DR
First Name:WIGBERT
Middle Name:SAUL
Last Name:GODOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 26246
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-6246
Mailing Address - Country:US
Mailing Address - Phone:718-604-5574
Mailing Address - Fax:718-604-5527
Practice Address - Street 1:585 SCHENECTADY AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203
Practice Address - Country:US
Practice Address - Phone:718-604-5421
Practice Address - Fax:718-604-5527
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213708208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY213708OtherNYS LICENSE