Healthcare Provider Details

I. General information

NPI: 1295169068
Provider Name (Legal Business Name): SANJAY GOSWAMI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2013
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8432 MAPLE LN
RIVERSIDE CA
92508-6303
US

IV. Provider business mailing address

5512 138TH ST
FLUSHING NY
11355-5036
US

V. Phone/Fax

Practice location:
  • Phone: 951-577-4522
  • Fax:
Mailing address:
  • Phone: 631-839-2252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number024242
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: