Organization Active NPI

Goncharov Medical, P.C.

  • Obstetrics & Gynecology Physician
  • Brooklyn, NY
National Provider Identifier
1831580091
Registry record updated Aug 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
269283 Issued in NY
Legal business name
GONCHAROV MEDICAL, P.C.
Practice address
225 Saint Johns PL # Placec
Brooklyn, NY 11217-3405
Phone
(718) 517-8833
Fax
(646) 843-7617
NPI assigned
Feb 10, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2024

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

Authorized official

Name
Dimitry GoncharovNPI 1457657280
Title
President
Phone
(212) 201-1217

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X 269283 NY Primary

Addresses

Primary practice location

225 Saint Johns PL # Placec
Brooklyn, NY 11217-3405

Mailing address

225 Saint Johns PL # Placec
Brooklyn, NY 11217-3405
Phone (718) 517-8833

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150327000624 NY Part B Supplier - Clinic/Group Practice 2062739246 Receives reassigned benefits from 29 practitioners
Practice locations: New York, NY; Rego Park, NY; Brooklyn, NY

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D2276047Goncharov Medical PC225 Saint Johns Place, Brooklyn, NY 11217Certificate of waiverJan 31, 2027

National Provider Directory

National Provider Directory

Locations

225 Saint Johns Pl
Brooklyn, NY 11217
Phone (718) 517-8833

274 Madison Ave
Rm 300
New York, NY 10016
Phone (212) 201-1217

1221 Lexington Ave
New York, NY 10028
Phone (212) 201-1217

32 W 20th St
New York, NY 10011
Phone (212) 201-1217

12 E 53rd St
New York, NY 10022
Phone (212) 201-1217

151 W 30th St
Ste 403
New York, NY 10001
Phone (212) 201-1217

Practitioners & affiliated clinicians

Practitioners 31

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1423526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724112000000",
    "number": "1831580091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 SAINT JOHNS PL # PLACEC",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112173405",
            "telephone_number": "718-517-8833",
            "fax_number": "347-529-5296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 SAINT JOHNS PL # PLACEC",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112173405",
            "telephone_number": "718-517-8833",
            "fax_number": "646-843-7617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GONCHAROV MEDICAL, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-10",
        "last_updated": "2024-08-20",
        "certification_date": "2024-08-20",
        "status": "A",
        "authorized_official_last_name": "GONCHAROV",
        "authorized_official_first_name": "DIMITRY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "212-201-1217"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "NY",
            "license": "269283",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.