MEDICARE: DR. BARBARA GOLDSTEIN 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
1	231H00000X	Audiologist	00065	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4524005	OTHER	NY	AETNA

General Provider Information

NPI Number	:	1154547107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARBARA GOLDSTEIN PH.D.

Provider Business Mailing Address
First Line	:	744 SPARROW DR
Second Line	:
City	:	STAMFORD
State	:	VT
Zip	:	05352-9667
Country	:	US
Telephone Number	:	802-694-1239
Fax Number	:	802-694-1720

Provider Business Practice Location Address
First Line	:	11835 QUEENS BLVD
Second Line	:	SUITE 1430
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-7200
Country	:	US
Telephone Number	:	718-773-8888
Fax Number	:	718-261-1915

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	07/08/2007

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