Healthcare Provider Details

I. General information

NPI: 1780187575
Provider Name (Legal Business Name): ADITYA GOYAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ADITYA GOYAL MD

II. Dates (important events)

Enumeration Date: 03/17/2018
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E 77TH ST
NEW YORK NY
10075-1850
US

IV. Provider business mailing address

100 E 77TH ST
NEW YORK NY
10075-1850
US

V. Phone/Fax

Practice location:
  • Phone: 212-424-6500
  • Fax:
Mailing address:
  • Phone: 212-434-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number328460
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number328460
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number328460
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: