Provider Demographics
NPI:1053324780
Name:YURYEV-GOLGER, INNA N (MD)
Entity Type:Individual
Prefix:DR
First Name:INNA
Middle Name:N
Last Name:YURYEV-GOLGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 OCEAN AVE UNIT 1F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3576
Mailing Address - Country:US
Mailing Address - Phone:718-444-7774
Mailing Address - Fax:718-444-7775
Practice Address - Street 1:2409 OCEAN AVE UNIT 1F
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3576
Practice Address - Country:US
Practice Address - Phone:718-616-2073
Practice Address - Fax:718-444-7775
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2018-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2053852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01765806Medicaid
NYW87041Medicare ID - Type Unspecified
NY01765806Medicaid