Active NPI
Nicole Golbari
- MOHS-Micrographic Surgery Physician
- Port Jefferson, NY
National Provider Identifier
1255891016
On this page
Key facts
NPPES NPI Registry- Primary specialty
- MOHS-Micrographic Surgery Physician
- License
- 333046
- Practice address
- 75 N Country Rd
Port Jefferson, NY 11777-2119 - Phone
- (631) 686-2517
- NPI assigned
- Mar 20, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 333046 | NY | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| MOHS-Micrographic Surgery Physician | 207ND0101X | 333046 | NY | Primary |
Addresses
Primary practice location
75 N Country Rd
Port Jefferson, NY 11777-2119
Mailing address
75 N Country Rd
Port Jefferson, NY 11777-2119
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Dermatology
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
111 Broadway
New York, NY 10006-1901
Phone (212) 263-9700
259 1St St
Mineola, NY 11501-3957
Phone (516) 222-8600
Hospital & facility affiliations
- NYU Langone Hospitals
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 88 |
| Removal of tissue | 1-10 |
| Removal of skin lesions | 127 |
| Removal of skin cancer | 363 |
| Skin biopsy | 66 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| New York University | Current | Accepting new patients | |
| New York University | Current | Accepting new patients |
Locations
700 Hicksville Rd
Ste 205
Bethpage, NY 11714
Phone (646) 501-3325
1111 Franklin Ave
Garden City, NY 11530
Phone (516) 222-8600
13303 Jamaica Ave
Richmond Hill, NY 11418
Phone (718) 206-6942
Networks
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H3359
Interoperability endpoints
- ngolbari683950@nyumc.direct-ci.com
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Medicine & Rehabilitation Physician
- Boynton Beach, FL
- NPI 1104787613
Hospital & facility affiliations 7
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Rehabilitation Hospital Unit
- New York, NY
- NPI 1275632895
-
- General Acute Care Hospital
- Mineola, NY
- NPI 1427616002
-
- General Acute Care Hospital
- Brooklyn, NY
- NPI 1619341716
-
- General Acute Care Hospital
- New York, NY
- NPI 1669578324
-
- General Acute Care Hospital
- New York, NY
- NPI 1801992631
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1553040000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1768521600000",
"number": "1255891016",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "75 N COUNTRY RD",
"city": "PORT JEFFERSON",
"state": "NY",
"postal_code": "117772119"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "75 N COUNTRY RD",
"city": "PORT JEFFERSON",
"state": "NY",
"postal_code": "117772119",
"telephone_number": "631-686-2517"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOLBARI",
"first_name": "NICOLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-03-20",
"last_updated": "2026-01-16",
"certification_date": "2026-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "NY",
"license": "333046",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "207ND0101X",
"taxonomy_group": "",
"desc": "Dermatology, MOHS-Micrographic Surgery",
"state": "NY",
"license": "333046",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Jefferson, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.