Healthcare Provider Details

I. General information

NPI: 1639229537
Provider Name (Legal Business Name): EVA GOMOLINSKI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8008 3RD AVE
BROOKLYN NY
11209-3802
US

IV. Provider business mailing address

8008 3RD AVE
BROOKLYN NY
11209-3802
US

V. Phone/Fax

Practice location:
  • Phone: 718-833-3636
  • Fax: 718-833-4428
Mailing address:
  • Phone: 718-833-3636
  • Fax: 718-833-4428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number152605
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: