MEDICARE: JOSEPH GOLDSTEIN

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	106E00000X	Assistant Behavior Analyst	103K00000X	NJ
2	106E00000X	Assistant Behavior Analyst		NJ

General Provider Information

NPI Number	:	1558256057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH GOLDSTEIN

Provider Business Mailing Address
First Line	:	330 MILLER RD
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-2337
Country	:	US
Telephone Number	:	848-223-2756
Fax Number	:

Provider Business Practice Location Address
First Line	:	1657 HIDDEN LN
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-3912
Country	:	US
Telephone Number	:	848-223-2756
Fax Number	:

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

Provider Enumeration Date	:	06/12/2025
Last Update Date	:	06/12/2025

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