Provider Demographics
NPI:1780793604
Name:GOSWAMY, NEERAJ (MD)
Entity type:Individual
Prefix:DR
First Name:NEERAJ
Middle Name:
Last Name:GOSWAMY
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 1:111 MITCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3819
Mailing Address - Country:US
Mailing Address - Phone:516-432-2368
Mailing Address - Fax:516-526-9030
Practice Address - Street 1:111 MITCHELL AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3819
Practice Address - Country:US
Practice Address - Phone:516-432-2368
Practice Address - Fax:516-526-9030
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221367-1207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02460924Medicaid
NY685E31Medicare ID - Type Unspecified
NYI00403Medicare UPIN