Provider Demographics
NPI:1326699679
Name:GOYKHBERG, TATYANA (PMHNP)
Entity type:Individual
Prefix:
First Name:TATYANA
Middle Name:
Last Name:GOYKHBERG
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4190 SUNRISE HIGHWAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758
Mailing Address - Country:US
Mailing Address - Phone:516-765-7799
Mailing Address - Fax:334-212-0233
Practice Address - Street 1:4190 SUNRISE HIGHWAY
Practice Address - Street 2:SUITE A
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758
Practice Address - Country:US
Practice Address - Phone:516-765-7799
Practice Address - Fax:334-212-0233
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY402843363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY402843OtherSTATE LICENSE