Healthcare Provider Details

I. General information

NPI: 1902719529
Provider Name (Legal Business Name): GOLOVKO PRIMARY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 FELA DR
OLD BRIDGE NJ
08857-3534
US

IV. Provider business mailing address

17 FELA DR
OLD BRIDGE NJ
08857-3534
US

V. Phone/Fax

Practice location:
  • Phone: 732-439-4662
  • Fax:
Mailing address:
  • Phone: 732-439-4662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LYUBOMYR GOLOVKO
Title or Position: APN
Credential:
Phone: 732-439-4662