Provider Demographics
NPI:1003087917
Name:GOLDHAGEN, GREGG A (MS)
Entity Type:Individual
Prefix:MR
First Name:GREGG
Middle Name:A
Last Name:GOLDHAGEN
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:19 BRADHURST AVE STE 3100N
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-2140
Mailing Address - Country:US
Mailing Address - Phone:914-909-9018
Mailing Address - Fax:914-909-9028
Practice Address - Street 1:210 E 86TH ST
Practice Address - Street 2:9TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-3003
Practice Address - Country:US
Practice Address - Phone:212-722-5570
Practice Address - Fax:212-722-4573
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001030237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400000961Medicare PIN