Provider Demographics
NPI:1861511610
Name:GOLUBCHIK, ANNETA VLADIMIROVNA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNETA
Middle Name:VLADIMIROVNA
Last Name:GOLUBCHIK
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 1:20 OVERLOOK RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07046-1509
Mailing Address - Country:US
Mailing Address - Phone:732-404-0044
Mailing Address - Fax:
Practice Address - Street 1:5 DUNDEE AVE
Practice Address - Street 2:
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830-2118
Practice Address - Country:US
Practice Address - Phone:732-404-0044
Practice Address - Fax:732-218-3933
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA268684207RI0200X
NJ25MA08153500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0257559Medicaid
NJ195515VSDMedicare PIN