Provider Demographics
NPI:1770631186
Name:GOLDIN, LEONID (MD)
Entity Type:Individual
Prefix:MR
First Name:LEONID
Middle Name:
Last Name:GOLDIN
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 1:1625 EMMONS AVE MEDICAL OFFICE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235
Mailing Address - Country:US
Mailing Address - Phone:718-368-2736
Mailing Address - Fax:718-368-1438
Practice Address - Street 1:1625 EMMONS AVE MEDICAL OFFICE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235
Practice Address - Country:US
Practice Address - Phone:718-368-2736
Practice Address - Fax:718-368-1438
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY178999207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01135042Medicaid
NY01135042Medicaid
NY19F781Medicare PIN