Healthcare Provider Details

I. General information

NPI: 1609713213
Provider Name (Legal Business Name): GOLYAN MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

287 NORTHERN BLVD STE 108
GREAT NECK NY
11021-4717
US

IV. Provider business mailing address

PO BOX 234417
GREAT NECK NY
11023-4417
US

V. Phone/Fax

Practice location:
  • Phone: 516-423-6141
  • Fax:
Mailing address:
  • Phone: 516-423-6141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: FARAIDOON GOLYAN
Title or Position: OWNER
Credential:
Phone: 516-423-6141