Healthcare Provider Details

I. General information

NPI: 1326051400
Provider Name (Legal Business Name): MAYA GOLBRAYKH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7031 108TH ST SUITE 10
FOREST HILLS NY
11375-4424
US

IV. Provider business mailing address

7031 108TH STREET SUITE 10
FOREST HILLS NY
11375-4455
US

V. Phone/Fax

Practice location:
  • Phone: 718-575-2200
  • Fax: 718-575-2206
Mailing address:
  • Phone: 718-575-2200
  • Fax: 718-575-2206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number240658
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number240658
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: