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NPI Code Detail

MEDICARE: DR. LISA TAXMAN GOLDFARB PH.D.

MEDICARE: DR. LISA TAXMAN GOLDFARB 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
1103T00000XPsychologist011631NY

General Provider Information

NPI Number : 1235447053
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LISA TAXMAN GOLDFARB PH.D.
Provider Business Mailing Address
First Line : 23 HOLLY BERRY CT
Second Line :
City : WADING RIVER
State : NY
Zip : 11792-2157
Country : US
Telephone Number : 516-503-1553
Fax Number :
Provider Business Practice Location Address
First Line : 118 SPRING ST
Second Line :
City : PORT JEFFERSON
State : NY
Zip : 11777-1817
Country : US
Telephone Number : 631-476-0564
Fax Number : 631-476-9322
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2010
Last Update Date : 09/14/2010

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