MEDICARE: ESTER GOLDVARG

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	103TC0700X	Clinical Psychologist	020530-1	NY

General Provider Information

NPI Number	:	1619397270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ESTER GOLDVARG

Provider Business Mailing Address
First Line	:	2015 E 67TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-6007
Country	:	US
Telephone Number	:	917-216-9638
Fax Number	:	718-621-0002

Provider Business Practice Location Address
First Line	:	5322 AVENUE N
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-3910
Country	:	US
Telephone Number	:	917-216-9638
Fax Number	:	718-621-0002

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

Provider Enumeration Date	:	04/22/2014
Last Update Date	:	05/23/2014

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