Basic Information
| Provider Information | |||||||||
| NPI: | 1942761135 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GOBINDA PAUL PHYSICIAN PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8738 168TH PL | ||||||||
| Address2: | |||||||||
| City: | JAMAICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114323630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5619104949 | ||||||||
| FaxNumber: | 7188417499 | ||||||||
| Practice Location | |||||||||
| Address1: | 8738 168TH PL | ||||||||
| Address2: | |||||||||
| City: | JAMAICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114323630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188740076 | ||||||||
| FaxNumber: | 7188417499 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2019 | ||||||||
| LastUpdateDate: | 12/17/2019 | ||||||||
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| AuthorizedOfficialLastName: | PAUL | ||||||||
| AuthorizedOfficialFirstName: | GOBINDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5619104949 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 12/17/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 04226404 | 05 | NY | MEDICAID |