Provider Demographics
NPI:1932209657
Name:GOH, MAGNOLIA L (AC)
Entity Type:Individual
Prefix:MS
First Name:MAGNOLIA
Middle Name:L
Last Name:GOH
Suffix:
Gender:F
Credentials:AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W 57 STREET,
Mailing Address - Street 2:#629
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10107
Mailing Address - Country:US
Mailing Address - Phone:212-258-5622
Mailing Address - Fax:
Practice Address - Street 1:250 W 57 STREET,
Practice Address - Street 2:#629
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10107
Practice Address - Country:US
Practice Address - Phone:212-258-5622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000146171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246075Medicaid
NY00330128Medicare ID - Type Unspecified