1174754311 NPI number — DR. SIMONA GOSCHIN M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174754311 NPI number — DR. SIMONA GOSCHIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOSCHIN
Provider First Name:
SIMONA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174754311
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
317 E 17TH ST
Provider Second Line Business Mailing Address:
SUITE 5F09
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10003-3804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-420-4352
Provider Business Mailing Address Fax Number:
212-420-4332

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
317 E 17TH ST
Provider Second Line Business Practice Location Address:
SUITE 5F09
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10003-3804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-420-4352
Provider Business Practice Location Address Fax Number:
212-420-4332
Provider Enumeration Date:
08/05/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 03869005 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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