Provider Demographics
NPI:1164400156
Name:GOYAL, SANJAY (MD)
Entity Type:Individual
Prefix:DR
First Name:SANJAY
Middle Name:
Last Name:GOYAL
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 1:6 ORTON DR
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-3620
Mailing Address - Country:US
Mailing Address - Phone:718-806-1609
Mailing Address - Fax:718-806-1693
Practice Address - Street 1:2280 GRAND AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-3164
Practice Address - Country:US
Practice Address - Phone:516-378-3373
Practice Address - Fax:516-378-1045
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190916-1207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01579102Medicaid
NY742291Medicare PIN
NY01579102Medicaid