MEDICARE: GOLDIE GOLD

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

General Provider Information

NPI Number	:	1831494111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GOLDIE GOLD

Provider Business Mailing Address
First Line	:	1563 E 31ST ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-3454
Country	:	US
Telephone Number	:	347-325-2430
Fax Number	:

Provider Business Practice Location Address
First Line	:	1563 E 31ST ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-3454
Country	:	US
Telephone Number	:	347-325-2430
Fax Number	:

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

Provider Enumeration Date	:	01/18/2011
Last Update Date	:	12/28/2021

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Directions to “ GOLDIE GOLD ” Practice Location

Language	Start Address	Practice Location

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