Provider Demographics
NPI:1104992890
Name:GOULART, HAMILTON C (MD)
Entity type:Individual
Prefix:DR
First Name:HAMILTON
Middle Name:C
Last Name:GOULART
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 1:225 DAYTON ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-4407
Mailing Address - Country:US
Mailing Address - Phone:201-612-0020
Mailing Address - Fax:201-612-7238
Practice Address - Street 1:225 DAYTON ST
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-4407
Practice Address - Country:US
Practice Address - Phone:201-612-0020
Practice Address - Fax:201-612-7238
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04027000207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJB19156Medicare UPIN