Provider Demographics
NPI:1447296421
Name:GOLDVUG, RITA (MD)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:GOLDVUG
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 1:49 LASALLE AVE
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-1207
Mailing Address - Country:US
Mailing Address - Phone:718-896-7777
Mailing Address - Fax:718-896-7770
Practice Address - Street 1:9830 67TH AVE STE GG
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4944
Practice Address - Country:US
Practice Address - Phone:718-896-7777
Practice Address - Fax:718-896-7770
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196541207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01758612Medicaid
NYF86023Medicare UPIN
NY01758612Medicaid