Provider Demographics
NPI:1295789253
Name:GOLOUBENKO, OLEG (MD)
Entity type:Individual
Prefix:
First Name:OLEG
Middle Name:
Last Name:GOLOUBENKO
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 1:1000 MONTAUK HWY
Mailing Address - Street 2:GOOD SAMARITAN HOSPITAL CENTER
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795
Mailing Address - Country:US
Mailing Address - Phone:631-376-3535
Mailing Address - Fax:631-376-3205
Practice Address - Street 1:1000 MONTAUK HWY
Practice Address - Street 2:GOOD SAMARITAN HOSPITAL CENTER
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795
Practice Address - Country:US
Practice Address - Phone:631-376-3535
Practice Address - Fax:631-376-3205
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230766208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics