Healthcare Provider Details

I. General information

NPI: 1073594925
Provider Name (Legal Business Name): STANISLAV GOLYAND DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4032 RICHMOND AVE
STATEN ISLAND NY
10312-5113
US

IV. Provider business mailing address

4032 RICHMOND AVE
STATEN ISLAND NY
10312-5113
US

V. Phone/Fax

Practice location:
  • Phone: 718-948-6500
  • Fax: 718-948-0255
Mailing address:
  • Phone: 718-948-6500
  • Fax: 718-948-0255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number050229
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: