Healthcare Provider Details

I. General information

NPI: 1679563811
Provider Name (Legal Business Name): ALINA GOULLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 04/02/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 W 52ND ST FL 3
NEW YORK NY
10019-6239
US

IV. Provider business mailing address

PO BOX 95000-2433
PHILADELPHIA PA
19195-2433
US

V. Phone/Fax

Practice location:
  • Phone: 646-754-2100
  • Fax:
Mailing address:
  • Phone: 212-420-3917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number209284
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: