Micheline Goulart, M.D.

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

315500 Issued in NY

Practice address

1045 Northern Blvd FL 2
Roslyn, NY 11576-1502

Phone

(516) 279-2616

Fax

(516) 279-2632

NPI assigned

May 18, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Micheline Moore Former name

Electronic endpoints 1

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mgoulart507952@nyumc.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Island Cosmetic and Reconstructive Surgery PLLC

  dba Island Plastic Surgery

  • Plastic Surgery Physician
  • Mineola, NY
  • NPI 1013038702
  Medicare reassignment NPD
• Jeremy Nikfarjam Medical, PC

  • Dermatology Physician
  • Roslyn, NY
  • NPI 1346110202
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1431907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686614400000",
    "number": "1568840940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 NORTHERN BLVD STE 6",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110215314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1045 NORTHERN BLVD FL 2",
            "city": "ROSLYN",
            "state": "NY",
            "postal_code": "115761502",
            "telephone_number": "516-279-2616",
            "fax_number": "516-279-2632"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1615 Northern Blvd Ste Gr1",
            "address_purpose": "LOCATION",
            "city": "Manhasset",
            "state": "NY",
            "postal_code": "110303008",
            "country_code": "US",
            "telephone_number": "516-279-2616",
            "fax_number": "516-279-2632",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOULART",
        "first_name": "MICHELINE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-18",
        "last_updated": "2023-06-13",
        "certification_date": "2023-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "NY",
            "license": "315500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "roslyn",
            "affiliation": "N",
            "address_1": "1045 Northern Blvd",
            "city": "Roslyn",
            "state": "NY",
            "country_code": "US",
            "postal_code": "115761502",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MICHELINE",
            "last_name": "MOORE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sandra Goldman, PT
• Leonard James Good, MD
• Diana Goodenough, LCSW
• Kenneth Goodman, M.D.
• Sari Lee Gordon, OD
• Helene Danielle Gourdet, PHYSICIAN ASSISTANT
• Danielle Gournelos
• Dev Raj Goyal, MD
• John Paul Gozaloff, PT
• John Graffeo, P.A.

• Plastic and Reconstructive Surgery Physician in Roslyn, NY
• Providers in Roslyn, NY by specialty
• Plastic and Reconstructive Surgery Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.