Provider Demographics
NPI:1790728244
Name:GOYAL, MADHULIKA (MD)
Entity Type:Individual
Prefix:
First Name:MADHULIKA
Middle Name:
Last Name:GOYAL
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 1:7420 58TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-5207
Mailing Address - Country:US
Mailing Address - Phone:718-806-1609
Mailing Address - Fax:
Practice Address - Street 1:2280 GRAND AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-3164
Practice Address - Country:US
Practice Address - Phone:516-705-6218
Practice Address - Fax:516-378-1045
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203432208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01726003Medicaid
NY5B9791Medicare PIN
NYC56757Medicare UPIN