Provider Demographics
NPI:1942281035
Name:GOLIN, STAN (MD)
Entity type:Individual
Prefix:
First Name:STAN
Middle Name:
Last Name:GOLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:STANISLAV
Other - Middle Name:
Other - Last Name:GOLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1 HOLLOW LN STE 206
Mailing Address - Street 2:
Mailing Address - City:LAKE SUCCESS
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1215
Mailing Address - Country:US
Mailing Address - Phone:516-931-0041
Mailing Address - Fax:
Practice Address - Street 1:3111 NEW HYDE PARK RD
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1209
Practice Address - Country:US
Practice Address - Phone:516-394-9600
Practice Address - Fax:516-869-3015
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA078171002085R0001X
NY2261112085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02580647Medicaid
I18204Medicare UPIN
2360E1Medicare ID - Type Unspecified