MEDICARE: ANGELA GOLDMAN M.A., CCC-S.L.P.

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	014419-1	NY

General Provider Information

NPI Number	:	1447572383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA GOLDMAN M.A., CCC-S.L.P.

Provider Business Mailing Address
First Line	:	370 ASHLAND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-3056
Country	:	US
Telephone Number	:	718-605-0864
Fax Number	:

Provider Business Practice Location Address
First Line	:	370 ASHLAND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-3056
Country	:	US
Telephone Number	:	718-605-0864
Fax Number	:

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

Provider Enumeration Date	:	02/19/2010
Last Update Date	:	02/19/2010

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