MEDICARE: MRS. YEKATERINA GOLDBERG M.S., CCC-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	018159	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619119419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. YEKATERINA GOLDBERG M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	8858 BAY 16TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-5902
Country	:	US
Telephone Number	:	917-434-1972
Fax Number	:

Provider Business Practice Location Address
First Line	:	1659 78TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-1011
Country	:	US
Telephone Number	:	718-234-1212
Fax Number	:

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

Provider Enumeration Date	:	03/25/2009
Last Update Date	:	07/26/2010

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Directions to “ MRS. YEKATERINA GOLDBERG M.S., CCC-SLP” Practice Location

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