Provider Demographics
NPI:1831580091
Name:GONCHAROV MEDICAL, P.C.
Entity type:Organization
Organization Name:GONCHAROV MEDICAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIMITRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GONCHAROV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-201-1217
Mailing Address - Street 1:225 SAINT JOHNS PL # PLACEC
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-3405
Mailing Address - Country:US
Mailing Address - Phone:718-517-8833
Mailing Address - Fax:347-529-5296
Practice Address - Street 1:225 SAINT JOHNS PL # PLACEC
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-3405
Practice Address - Country:US
Practice Address - Phone:718-517-8833
Practice Address - Fax:646-843-7617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY269283207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty