Basic Information
Provider Information
NPI: 1124136338
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GOBIN
FirstName: YVES
MiddleName: PIERRE
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 575 LEXINGTON AVE
Address2: 5TH FL.
City: NEW YORK
State: NY
PostalCode: 100226102
CountryCode: US
TelephoneNumber: 2125905152
FaxNumber: 2125907800
Practice Location
Address1: 525 E 68TH ST
Address2: ST 626/BOX99
City: NEW YORK
State: NY
PostalCode: 100214870
CountryCode: US
TelephoneNumber: 2127464776
FaxNumber: 2127466607
Other Information
ProviderEnumerationDate: 08/28/2006
LastUpdateDate: 09/20/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207T00000X222745NYY Allopathic & Osteopathic PhysiciansNeurological Surgery 

ID Information
IDTypeStateIssuerDescription
0220835905NY MEDICAID


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