Provider Demographics
NPI:1033580949
Name:GOLDSTEIN, CHAYA (MS ED)
Entity Type:Individual
Prefix:
First Name:CHAYA
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2A IROQUOIS TRL
Mailing Address - Street 2:
Mailing Address - City:AIRMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10952-4923
Mailing Address - Country:US
Mailing Address - Phone:347-683-9240
Mailing Address - Fax:
Practice Address - Street 1:2A IROQUOIS TRL
Practice Address - Street 2:
Practice Address - City:AIRMONT
Practice Address - State:NY
Practice Address - Zip Code:10952-4923
Practice Address - Country:US
Practice Address - Phone:347-683-9240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1381877174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCB56648CMedicaid