Provider Demographics
NPI:1356344550
Name:GOLUB, CARY MILES (DPM)
Entity type:Individual
Prefix:DR
First Name:CARY
Middle Name:MILES
Last Name:GOLUB
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:854 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-4758
Mailing Address - Country:US
Mailing Address - Phone:516-889-2200
Mailing Address - Fax:516-889-4444
Practice Address - Street 1:854 E BROADWAY
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-4758
Practice Address - Country:US
Practice Address - Phone:516-889-2200
Practice Address - Fax:516-889-4444
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005037213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01452900Medicaid
NY5606060001Medicare NSC
NYU39444Medicare UPIN