Provider Demographics
NPI:1114186376
Name:GOUSKOVA, TATIANA (MD)
Entity Type:Individual
Prefix:DR
First Name:TATIANA
Middle Name:
Last Name:GOUSKOVA
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 1:119 W 124TH ST
Mailing Address - Street 2:ARTC, STARTING POINT CLINIC
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-4920
Mailing Address - Country:US
Mailing Address - Phone:212-865-2007
Mailing Address - Fax:212-865-2472
Practice Address - Street 1:119 W 124TH ST
Practice Address - Street 2:ARTC, STARTING POINT CLINIC
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4920
Practice Address - Country:US
Practice Address - Phone:212-865-2007
Practice Address - Fax:212-865-2472
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2012-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY248236-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00244606Medicaid