Provider Demographics
NPI:1235137548
Name:KINGSTON NEUROLOGICAL ASSOCIATES,P.C.
Entity Type:Organization
Organization Name:KINGSTON NEUROLOGICAL ASSOCIATES,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:GOOCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-331-5165
Mailing Address - Street 1:365 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-5151
Mailing Address - Country:US
Mailing Address - Phone:845-331-5165
Mailing Address - Fax:845-331-6238
Practice Address - Street 1:365 BROADWAY
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-5151
Practice Address - Country:US
Practice Address - Phone:845-331-5165
Practice Address - Fax:845-331-6238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1637992084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty