Individual
LIDIA B KOULOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
70 HATFIELD LN, SUITE 101, GOSHEN, NY 10924-6734
(845) 294-8888
(845) 294-1669
Mailing address
20 GRAND ST, 3RD FL, WARWICK, NY 10990-1035
(845) 294-8888
(845) 987-5979
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
234815
NY
207RH0003X
Hematology & Oncology Physician
Primary
234815
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02638984
—
NY
01
—
P00244709
RAILROAD MEDICARE PIN
NY
Enumeration date
01/12/2006
Last updated
07/03/2018
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