1366639247 NPI number — STEVEN A GOLUB MD, PLLC

Table of content: (NPI 1366639247)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366639247 NPI number — STEVEN A GOLUB MD, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEVEN A GOLUB MD, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1366639247
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
602 MERRICK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST MEADOW
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11554-4731
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-481-2000
Provider Business Mailing Address Fax Number:
516-481-7690

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
602 MERRICK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST MEADOW
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11554-4731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-481-2000
Provider Business Practice Location Address Fax Number:
516-481-7690
Provider Enumeration Date:
09/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GOLUB
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
515-481-2000

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  151991 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: WJ6851 . This is a "MEDICARE IDENTIFICATION #" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com