Provider Demographics
NPI:1811288186
Name:GOLDMAN, BRUCE NEIL (MA SLP)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:NEIL
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:MA SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 CEDARHURST STREET
Mailing Address - Street 2:
Mailing Address - City:NORTH WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11581
Mailing Address - Country:US
Mailing Address - Phone:516-428-9244
Mailing Address - Fax:
Practice Address - Street 1:1030 CEDARHURST STREET
Practice Address - Street 2:
Practice Address - City:NORTH WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11581
Practice Address - Country:US
Practice Address - Phone:516-428-9244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002006-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist