Provider Demographics
NPI:1972540862
Name:GOLKOW, RUSSELL STUART (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:STUART
Last Name:GOLKOW
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 1:142 PALISADE AVE
Mailing Address - Street 2:RADIOLOGY PROFESSIONAL ASSOCIATION
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306
Mailing Address - Country:US
Mailing Address - Phone:201-795-8411
Mailing Address - Fax:
Practice Address - Street 1:142 PALISADE AVE
Practice Address - Street 2:RADIOLOGY PROFESSIONAL ASSOCIATION
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306
Practice Address - Country:US
Practice Address - Phone:201-795-8411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220790174400000X
NJ25MA03614200174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02168638Medicaid
NY10657403OtherCAQH
NY02168638Medicaid
NYC63116Medicare UPIN