Healthcare Provider Details

I. General information

NPI: 1770048381
Provider Name (Legal Business Name): ALIZA GOLDSTEIN AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2019
Last Update Date: 02/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 E 5TH ST
LAKEWOOD NJ
08701-3504
US

IV. Provider business mailing address

607 E 5TH ST
LAKEWOOD NJ
08701-3504
US

V. Phone/Fax

Practice location:
  • Phone: 347-486-1347
  • Fax:
Mailing address:
  • Phone: 347-486-1347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number25MG00145800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number41YA00102000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: