Provider Demographics
NPI:1508862137
Name:GOOHYA, USHA I (MD)
Entity Type:Individual
Prefix:
First Name:USHA
Middle Name:I
Last Name:GOOHYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 CONSTITUTION DRIVE
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:NY
Mailing Address - Zip Code:10962
Mailing Address - Country:US
Mailing Address - Phone:845-359-8123
Mailing Address - Fax:845-942-4223
Practice Address - Street 1:27 LIBERTY SQUARE MALL
Practice Address - Street 2:ROUTE 9W
Practice Address - City:STONY POINT
Practice Address - State:NY
Practice Address - Zip Code:10980-2400
Practice Address - Country:US
Practice Address - Phone:845-942-4222
Practice Address - Fax:845-942-4223
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226337207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02366636Medicaid
H85381Medicare UPIN
NY131AM1Medicare ID - Type Unspecified
NY02366636Medicaid