MEDICARE: ANDREW GOLOVATENKO PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	018716	NY

General Provider Information

NPI Number	:	1689050577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW GOLOVATENKO PA

Provider Business Mailing Address
First Line	:	2234 OCEAN AVE
Second Line	:	B3
City	:	BROOKLYN
State	:	NY
Zip	:	11229-2253
Country	:	US
Telephone Number	:	917-214-8682
Fax Number	:

Provider Business Practice Location Address
First Line	:	2234 OCEAN AVE
Second Line	:	B3
City	:	BROOKLYN
State	:	NY
Zip	:	11229-2253
Country	:	US
Telephone Number	:	917-214-8682
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2015
Last Update Date	:	06/06/2023

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