MEDICARE: MIRIAM GOLDSTEIN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	017874	NY

General Provider Information

NPI Number	:	1164662532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRIAM GOLDSTEIN PH.D.

Provider Business Mailing Address
First Line	:	319 AVENUE I
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-2617
Country	:	US
Telephone Number	:	718-375-8400
Fax Number	:

Provider Business Practice Location Address
First Line	:	319 AVENUE I
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-2617
Country	:	US
Telephone Number	:	718-375-8400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2009
Last Update Date	:	06/17/2026

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