Basic Information
| Provider Information | |||||||||
| NPI: | 1558351270 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GODEK | ||||||||
| FirstName: | HENRY | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 908 ALLEN ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011182533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137967494 | ||||||||
| FaxNumber: | 4137967498 | ||||||||
| Practice Location | |||||||||
| Address1: | 908 ALLEN ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011182533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137967494 | ||||||||
| FaxNumber: | 4137967498 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2005 | ||||||||
| LastUpdateDate: | 02/24/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 58126 | MA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.