Provider Demographics
NPI:1043218241
Name:GOLUB, SHELDON
Entity Type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:
Last Name:GOLUB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 NASSAU DR
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-2157
Mailing Address - Country:US
Mailing Address - Phone:516-829-9406
Mailing Address - Fax:516-466-4145
Practice Address - Street 1:11 NASSAU DR
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2157
Practice Address - Country:US
Practice Address - Phone:516-829-9406
Practice Address - Fax:516-466-4145
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY09227312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
0004353482OtherAETNA
3102892OtherOHI
NY01554521Medicaid
C12437Medicare UPIN
NY01554521Medicaid