Provider Demographics
NPI:1164508693
Name:GOPINATHAN, GOVINDAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GOVINDAN
Middle Name:
Last Name:GOPINATHAN
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 1:650 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3240
Mailing Address - Country:US
Mailing Address - Phone:212-213-9559
Mailing Address - Fax:212-689-6784
Practice Address - Street 1:650 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3240
Practice Address - Country:US
Practice Address - Phone:212-213-9559
Practice Address - Fax:212-689-6784
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1296362084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY53A971OtherPIN
NY53A971OtherPIN
NYWEV691Medicare ID - Type Unspecified