Provider Demographics
NPI:1306800636
Name:GOMOLIN, IRVING H (MD,)
Entity type:Individual
Prefix:DR
First Name:IRVING
Middle Name:H
Last Name:GOMOLIN
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
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Mailing Address - Street 1:222 STATION PLZ N
Mailing Address - Street 2:SUITE 518
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3808
Mailing Address - Country:US
Mailing Address - Phone:516-663-2588
Mailing Address - Fax:516-663-4644
Practice Address - Street 1:222 STATION PLZ N
Practice Address - Street 2:SUITE 518
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3808
Practice Address - Country:US
Practice Address - Phone:516-663-2588
Practice Address - Fax:516-663-4644
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2021-02-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY181465207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2208482Medicaid
NY2208482Medicaid
NYB84246Medicare UPIN