Provider Demographics
NPI:1679520696
Name:MCGOWAN, NINA (MD)
Entity type:Individual
Prefix:DR
First Name:NINA
Middle Name:
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:25 ELM PL FL 6
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5826
Mailing Address - Country:US
Mailing Address - Phone:718-855-3131
Mailing Address - Fax:718-855-4011
Practice Address - Street 1:25 ELM PL FL 6
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5826
Practice Address - Country:US
Practice Address - Phone:718-855-3131
Practice Address - Fax:718-855-4011
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2010252084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY74M681Medicare ID - Type Unspecified