Provider Demographics
NPI:1093212086
Name:GOLDVEKHT, GENNADIY (NP)
Entity Type:Individual
Prefix:MR
First Name:GENNADIY
Middle Name:
Last Name:GOLDVEKHT
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3045 BRIGHTON 12TH ST APT 3I
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-5742
Mailing Address - Country:US
Mailing Address - Phone:917-945-9040
Mailing Address - Fax:
Practice Address - Street 1:3101 OCEAN PKWY APT 1A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8403
Practice Address - Country:US
Practice Address - Phone:718-946-2481
Practice Address - Fax:718-266-5346
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304424-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health