Provider Demographics
NPI:1659380046
Name:GONCHAR, ALLA
Entity Type:Individual
Prefix:
First Name:ALLA
Middle Name:
Last Name:GONCHAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SHORE BLVD
Mailing Address - Street 2:UNIT 1G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4056
Mailing Address - Country:US
Mailing Address - Phone:718-615-9787
Mailing Address - Fax:
Practice Address - Street 1:10 SHORE BLVD
Practice Address - Street 2:UNIT 1G
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-4056
Practice Address - Country:US
Practice Address - Phone:718-615-9787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221707208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics