Healthcare Provider Details

I. General information

NPI: 1497945463
Provider Name (Legal Business Name): MICHELE GLAZER GOLDSTEIN M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3998 RED LION RD DEPARTMENT OF AUDIOLOGY
PHILADELPHIA PA
19114-1436
US

IV. Provider business mailing address

RED LION AND KNIGHTS ROADS
PHILADELPHIA PA
19114-1438
US

V. Phone/Fax

Practice location:
  • Phone: 215-612-5687
  • Fax: 213-612-4584
Mailing address:
  • Phone: 215-612-5687
  • Fax: 213-612-4584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAT000773L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: