Provider Demographics
NPI:1053471771
Name:GO, NUMERIANO (MD)
Entity Type:Individual
Prefix:
First Name:NUMERIANO
Middle Name:
Last Name:GO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2468 BROOKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309-2822
Mailing Address - Country:US
Mailing Address - Phone:518-372-5308
Mailing Address - Fax:518-388-9926
Practice Address - Street 1:2468 BROOKSHIRE DR
Practice Address - Street 2:
Practice Address - City:NISKAYUNA
Practice Address - State:NY
Practice Address - Zip Code:12309-2822
Practice Address - Country:US
Practice Address - Phone:518-372-5308
Practice Address - Fax:518-388-9926
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111288-1208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00632095Medicaid
NY32657BMedicare ID - Type Unspecified
NY00632095Medicaid