MEDICARE: AHUVA GOLDBURD SLP

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	235Z00000X	Speech-Language Pathologist	41YS00645200	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	41YS00645200	OTHER	NJ	NJ STATE LICENSE

General Provider Information

NPI Number	:	1215456355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AHUVA GOLDBURD SLP

Provider Business Mailing Address
First Line	:	95 CANARY DR
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5453
Country	:	US
Telephone Number	:	917-903-0667
Fax Number	:

Provider Business Practice Location Address
First Line	:	95 CANARY DR
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5453
Country	:	US
Telephone Number	:	917-903-0667
Fax Number	:

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

Provider Enumeration Date	:	09/09/2017
Last Update Date	:	07/21/2022

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Directions to “ AHUVA GOLDBURD SLP” Practice Location

Language	Start Address	Practice Location

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