BRYAN L GODDARD (NPI# 1780678169) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780678169 |
| Entity Type | Individual |
| Full Name | BRYAN L GODDARD |
| Credential | MD |
| Practice Address |
2524 Route 9w Ravena NY 12143-2804 |
| Mailing Address |
711 Troy Schenectady Rd Ste 203 Latham NY 12110-2461 |
| Practice Telephone | 5187567390 |
| Practice Fax Number | 5187568030 |
| Mailing Telephone | 5187823700 |
| Mailing Fax Number | 5187823799 |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2018-01-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | 2008004918 | MO | Allopathic & Osteopathic Physicians |
| Y | 207Q00000X | Family Medicine | 150318 | NY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | FIDELIS | 101115000088 | 01 |
| NY | AETNA | 4228179 | 01 |
| NY | GHI/HMO | 642981 | 01 |
| NY | EMPIRE BC | 6754C1 | 01 |
| NY | CDPHP | PRC110032213 | 01 |
| NY | 00751111 | 05 | |
| NY | SENIOR WHOLE HEALTH | 305800 | 01 |
| Street Address |
2524 ROUTE 9W |
| City | RAVENA |
| State | NY |
| Zip Code | 12143-2804 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972957769 | Bryan William Dworsky | Family Medicine | 2524 Route 9w, Ravena, NY 12143-2804 | 2016-04-18 |
| 1396181475 | Richard Anthony Galarza | Physician Assistant | 2524 Route 9w, Ravena, NY 12143-2850 | 2013-05-16 |
| 1205181914 | Ilona Snyder | Nurse Practitioner | 2524 Route 9w, Ravena, NY 12413-2804 | 2012-07-18 |
| 1992880348 | Patrick F Caulfield | Family Medicine | 2524 Route 9w, Ravena, NY 12413 | 2006-10-26 |
| 1770663791 | Richard W Jones | Family Medicine | 2524 Route 9w, Ravena, NY 12143 | 2006-10-16 |
| 1750471132 | Theresa A Sirico | Family Medicine | 2524 Route 9w, Ravena, NY 12143 | 2006-10-13 |
| 1548206956 | Sebastian Vincent Martorana | Physician Assistant | 2524 Route 9w, Ravena, NY 12143-2804 | 2006-06-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851817027 | Bryan Dyer | Pharmacist | Cvs - Faith Plaza, Route 9w, Ravena, NY 12143 | 2017-08-18 |
| 1124475553 | Brynn Saltis | Counselor | 249 Starr Rd., Ravena, NY 12143 | 2016-05-16 |
| 1346502135 | Stephanie Marie D'esposito | Specialist | 22 Wonder-vue Drive, Ravena, NY 12143 | 2012-06-08 |
| 1316224306 | Victoria Elizabeth Tesch | Speech-Language Pathologist | 15 Mountain Rd, Ravena-coeymans-selkirk Central School District, Ravena, NY 12143 | 2011-11-04 |
| 1245513001 | Patricia Lefevre | Registered Nurse | 2025 Rt 9w, Ravena, NY 12143 | 2011-09-27 |
| 1689957425 | Sandra Doane | Registered Nurse | 2025 Rt. 9w, Ravena, NY 12143 | 2011-09-27 |
| 1750604252 | Philip M Gatti | Pharmacist | Faith Plaza, Rt-9w, Ravena, NY 12143 | 2010-03-11 |
| 1043541105 | Brian J Touhey | Pharmacist | Faith Plaza Route 9w, Ravena, NY 12143 | 2010-01-28 |
| 1306016548 | Senior Projects of Ravena,inc | Taxi | 9 Bruno Blouvard, Ravena, NY 12143 | 2008-03-04 |
| 1891973558 | Kevin Michael Mocerine | Pharmacist | Faith Plaza Rt. 9w, Ravena, NY 12143 | 2008-02-05 |
| Find all providers in zip 12143 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093097586 | Community Care Physicians, PC | Family Medicine | 2524 Us Route 9w, Ravena, NY 12143-2804 | 2011-09-12 |
| 1972957769 | Bryan William Dworsky | Family Medicine | 2524 Route 9w, Ravena, NY 12143-2804 | 2016-04-18 |
| 1992880348 | Patrick F Caulfield | Family Medicine | 2524 Route 9w, Ravena, NY 12413 | 2006-10-26 |
| 1770663791 | Richard W Jones | Family Medicine | 2524 Route 9w, Ravena, NY 12143 | 2006-10-16 |
| 1750471132 | Theresa A Sirico | Family Medicine | 2524 Route 9w, Ravena, NY 12143 | 2006-10-13 |
| 1992898175 | Romeo Velasco Tamayo | Family Medicine | 33 Main St, Ravena, NY 12143-1930 | 2006-10-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881295558 | Mamoon Malik | Family Medicine | 90 Menands Rd, Albany, NY 12204-1400 | 2020-11-08 |
| 1336749571 | Chowdhury Medical PC | Family Medicine | 155 Alkier St, Brentwood, NY 11717-5129 | 2020-10-27 |
| 1356940084 | Rebecca Jean Smouse | Family Medicine | 1107 Prendergast Ave, Jamestown, NY 14701-3315 | 2020-10-23 |
| 1336748136 | Rapha House Calls | Family Medicine | 2 Fernglade Ct, Chester, NY 10918-2637 | 2020-10-22 |
| 1174122980 | Richmond Health Partners Ipa LLC | Family Medicine | 1161 Victory Blvd, Staten Island, NY 10301-3621 | 2020-10-22 |
| 1730787128 | Michael C Secallus | Family Medicine | 66 Kirkwood Gdns, Kirkwood, NY 13795-1623 | 2020-10-16 |
| 1861099053 | Julia Gross Family Health Nurse Practitioner, Pllc | Family Medicine | 950 Route 146 Ste 100, Clifton Park, NY 12065-3667 | 2020-10-01 |
| 1013523190 | Steinway Hope Medical LLC | Family Medicine | 8829 54th Ave Fl 2, Elmhurst, NY 11373-4543 | 2020-09-23 |
| 1538774500 | Jenny Brandt | Family Medicine | 3048 Sunset Ln # 2, Schenectady, NY 12303-5528 | 2020-09-15 |
| 1992319016 | Sarah Glaser | Family Medicine | 30 W 24th St, New York, NY 10010-3207 | 2020-09-04 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.