Provider Demographics
NPI:1073594925
Name:GOLYAND, STANISLAV (DDS)
Entity Type:Individual
Prefix:MR
First Name:STANISLAV
Middle Name:
Last Name:GOLYAND
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4032 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-5113
Mailing Address - Country:US
Mailing Address - Phone:718-948-6500
Mailing Address - Fax:718-948-0255
Practice Address - Street 1:4032 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-5113
Practice Address - Country:US
Practice Address - Phone:718-948-6500
Practice Address - Fax:718-948-0255
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050229122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02419836Medicaid