Provider Demographics
NPI:1174754311
Name:GOSCHIN, SIMONA (MD)
Entity type:Individual
Prefix:DR
First Name:SIMONA
Middle Name:
Last Name:GOSCHIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 E 17TH ST
Mailing Address - Street 2:SUITE 5F09
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3804
Mailing Address - Country:US
Mailing Address - Phone:212-420-4352
Mailing Address - Fax:212-420-4332
Practice Address - Street 1:317 E 17TH ST
Practice Address - Street 2:SUITE 5F09
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3804
Practice Address - Country:US
Practice Address - Phone:212-420-4352
Practice Address - Fax:212-420-4332
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03869005Medicaid