Provider Demographics
NPI:1255499000
Name:GOYKHBERG, BERNARD ALAN
Entity type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:ALAN
Last Name:GOYKHBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 AVENUE X
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2911
Mailing Address - Country:US
Mailing Address - Phone:718-814-7844
Mailing Address - Fax:
Practice Address - Street 1:39-50 CRESCENT ST SUITE D
Practice Address - Street 2:
Practice Address - City:LIC
Practice Address - State:NY
Practice Address - Zip Code:11101
Practice Address - Country:US
Practice Address - Phone:718-391-0303
Practice Address - Fax:718-391-0099
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048382183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist