Healthcare Provider Details

I. General information

NPI: 1790728244
Provider Name (Legal Business Name): MADHULIKA GOYAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 07/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2280 GRAND AVE SUITE 307
BALDWIN NY
11510-3164
US

IV. Provider business mailing address

7420 58TH AVE
MIDDLE VILLAGE NY
11379-5207
US

V. Phone/Fax

Practice location:
  • Phone: 516-705-6218
  • Fax: 516-378-1045
Mailing address:
  • Phone: 718-806-1609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number203432
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01726003
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: