Provider Demographics
NPI:1114231099
Name:GOLDMAN, CHARLES (MS CCC BRS-FD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:MS CCC BRS-FD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 8TH AVE
Mailing Address - Street 2:#10
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-1549
Mailing Address - Country:US
Mailing Address - Phone:917-796-0237
Mailing Address - Fax:
Practice Address - Street 1:101 8TH AVE
Practice Address - Street 2:#10
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-1549
Practice Address - Country:US
Practice Address - Phone:917-796-0237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000936-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist