Healthcare Provider Details

I. General information

NPI: 1811288186
Provider Name (Legal Business Name): BRUCE NEIL GOLDMAN MA SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2011
Last Update Date: 04/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 CEDARHURST STREET
NORTH WOODMERE NY
11581
US

IV. Provider business mailing address

1030 CEDARHURST STREET
NORTH WOODMERE NY
11581
US

V. Phone/Fax

Practice location:
  • Phone: 516-428-9244
  • Fax:
Mailing address:
  • Phone: 516-428-9244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number002006-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: