Provider Demographics
NPI:1922231604
Name:NEJATI, GOLALI (MD)
Entity Type:Individual
Prefix:DR
First Name:GOLALI
Middle Name:
Last Name:NEJATI
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 1:1270 FLATBUSH AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-7621
Mailing Address - Country:US
Mailing Address - Phone:718-940-9010
Mailing Address - Fax:718-940-9012
Practice Address - Street 1:1270 FLATBUSH AVE FL 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-7621
Practice Address - Country:US
Practice Address - Phone:718-940-9010
Practice Address - Fax:718-940-9012
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-28
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY254652207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1922231604OtherNPI
NY03158454Medicaid
A400018419Medicare PIN