Provider Demographics
NPI:1548483548
Name:GOEL, PREM C (MD)
Entity type:Individual
Prefix:DR
First Name:PREM
Middle Name:C
Last Name:GOEL
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 1:130 COACHMAN PL E
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-3053
Mailing Address - Country:US
Mailing Address - Phone:516-364-3832
Mailing Address - Fax:
Practice Address - Street 1:1390 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11239-2103
Practice Address - Country:US
Practice Address - Phone:718-642-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY126914207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00236677Medicaid
NY00236677Medicaid
NY291543Medicare ID - Type Unspecified