Provider Demographics
NPI:1285298810
Name:GOUGOL, NIKOU (MD)
Entity type:Individual
Prefix:DR
First Name:NIKOU
Middle Name:
Last Name:GOUGOL
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 1:1110 EASTERN PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-4881
Mailing Address - Country:US
Mailing Address - Phone:718-735-1900
Mailing Address - Fax:718-604-5450
Practice Address - Street 1:585 SCHENECTADY AVE STE K4
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1822
Practice Address - Country:US
Practice Address - Phone:718-363-6771
Practice Address - Fax:718-604-5450
Is Sole Proprietor?:No
Enumeration Date:2019-04-29
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY317591207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program