Provider Demographics
NPI:1710445259
Name:GOLTYAPIN, NIKITA (NRP, EMT-P)
Entity Type:Individual
Prefix:MR
First Name:NIKITA
Middle Name:
Last Name:GOLTYAPIN
Suffix:
Gender:M
Credentials:NRP, EMT-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 MELROSE PL
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-1638
Mailing Address - Country:US
Mailing Address - Phone:347-831-6619
Mailing Address - Fax:
Practice Address - Street 1:160 BROADWAY RM 1107
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-4212
Practice Address - Country:US
Practice Address - Phone:212-433-2956
Practice Address - Fax:877-682-2321
Is Sole Proprietor?:No
Enumeration Date:2019-03-04
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY454020146N00000X, 207PE0004X
2470A2800X
OHM5066222146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No2470A2800XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health InformationAssistant Record Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1578711891OtherNPI