Provider Demographics
NPI:1730260332
Name:KISHORE, GOPAL (MD)
Entity type:Individual
Prefix:DR
First Name:GOPAL
Middle Name:
Last Name:KISHORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:22411 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11427-2002
Mailing Address - Country:US
Mailing Address - Phone:718-479-9598
Mailing Address - Fax:516-520-5498
Practice Address - Street 1:4230 HEMPSTEAD TPKE
Practice Address - Street 2:SUITE 106
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-5700
Practice Address - Country:US
Practice Address - Phone:516-520-5507
Practice Address - Fax:516-520-5493
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2402342084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology