Provider Demographics
NPI:1407382989
Name:GOLOVKO, LYUBOMYR (APN)
Entity Type:Individual
Prefix:MR
First Name:LYUBOMYR
Middle Name:
Last Name:GOLOVKO
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 273
Mailing Address - Street 2:
Mailing Address - City:WHIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07981-0273
Mailing Address - Country:US
Mailing Address - Phone:973-535-8355
Mailing Address - Fax:973-535-8353
Practice Address - Street 1:568 ROUTE 10 W
Practice Address - Street 2:
Practice Address - City:WHIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07981-1516
Practice Address - Country:US
Practice Address - Phone:973-535-8355
Practice Address - Fax:973-535-8353
Is Sole Proprietor?:No
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00718000363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner