Provider Demographics
NPI:1265670657
Name:GOLDHIRSCH, LEORA GOLDA
Entity Type:Individual
Prefix:
First Name:LEORA
Middle Name:GOLDA
Last Name:GOLDHIRSCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEORA
Other - Middle Name:GOLDA
Other - Last Name:GOLDHIRSCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:881 CLIFFSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-3001
Mailing Address - Country:US
Mailing Address - Phone:516-791-0027
Mailing Address - Fax:
Practice Address - Street 1:881 CLIFFSIDE AVE
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-3001
Practice Address - Country:US
Practice Address - Phone:516-791-0027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004975-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist