Provider Demographics
NPI:1760507677
Name:GOYAL, ASHOK K (MD)
Entity Type:Individual
Prefix:
First Name:ASHOK
Middle Name:K
Last Name:GOYAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 LEWISTON GARDENS RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323-3753
Mailing Address - Country:US
Mailing Address - Phone:315-853-2580
Mailing Address - Fax:
Practice Address - Street 1:901 LEWISTON GARDENS RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NY
Practice Address - Zip Code:13323-3753
Practice Address - Country:US
Practice Address - Phone:315-853-2580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY154736207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY154736Medicaid
NYA62641Medicare UPIN