Provider Demographics
NPI:1326699679
Name:GOYKHBERG, TATYANA (PMHNP)
Entity Type:Individual
Prefix:
First Name:TATYANA
Middle Name:
Last Name:GOYKHBERG
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 PARK AVENUE
Mailing Address - Street 2:2ND FLOOR SUITE 9
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-3719
Mailing Address - Country:US
Mailing Address - Phone:516-931-0619
Mailing Address - Fax:516-879-3099
Practice Address - Street 1:3330 PARK AVENUE
Practice Address - Street 2:2ND FLOOR SUITE 9
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-3719
Practice Address - Country:US
Practice Address - Phone:516-765-7799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY402843363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY402843OtherSTATE LICENSE