Individual
PRATICHI KOTHARI GOENKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
26901 76TH AVE, CCMC, GME OFFICE, STE. 003, NEW HYDE PARK, NY 11040-1433
(631) 745-5659
Mailing address
26901 76TH AVE, CCMC, GME OFFICE, STE. 003, NEW HYDE PARK, NY 11040-1433
(631) 745-5659
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
25MA09227800
NJ
208000000X
Pediatrics Physician
261026-1
NY
208000000X
Pediatrics Physician
MD439291
PA
208000000X
Pediatrics Physician
Primary
MT190621
PA
Other
Enumeration date
08/20/2007
Last updated
07/30/2014
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