Provider Demographics
NPI:1083786693
Name:GOCHMAN, EVA RUTH (PHD)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:RUTH
Last Name:GOCHMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:EVA
Other - Middle Name:RUTH
Other - Last Name:GRUBLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:173 SOUTH COUNTRY ROAD
Mailing Address - Street 2:
Mailing Address - City:BELLPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11713
Mailing Address - Country:US
Mailing Address - Phone:631-776-1305
Mailing Address - Fax:631-776-1305
Practice Address - Street 1:173 SOUTH COUNTRY ROAD
Practice Address - Street 2:
Practice Address - City:BELLPORT
Practice Address - State:NY
Practice Address - Zip Code:11713
Practice Address - Country:US
Practice Address - Phone:631-776-1305
Practice Address - Fax:631-776-1305
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013367103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6149279OtherUBH
NYP1245281OtherOXFORD
R23109Medicare UPIN
NYV81101Medicare ID - Type Unspecified