Individual provider Active NPI

Stanley Curt Goldklang, PH.D.

  • Psychologist
  • Roslyn Heights, NY
National Provider Identifier
1033104146
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
007276-1 Issued in NY
Practice address
60 Glenwood LN
Roslyn Heights, NY 11577-1411
Phone
(516) 621-1025
Fax
(516) 621-3064
NPI assigned
Sep 14, 2005
Last updated
Jul 9, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 007276-1 NY Primary

Addresses

Primary practice location

60 Glenwood LN
Roslyn Heights, NY 11577-1411

Mailing address

60 Glenwood LN
Roslyn Heights, NY 11577-1411
Phone (516) 621-1025

Other identifiers 4

IdentifierTypeStateIssuer
0073403OtherGHI PROVIDER NUMBER
077594OtherNYVALUE OPTIONS
236510OtherMHN PROVIDER NUMBER
V26521MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040330001372 NY Practitioner - Clinical Psychologist 3779575980 Practice locations: Roslyn Heights, NY

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
New York University School of Medicine, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

60 Glenwood LN
Roslyn Heights, NY 11577-1411
Phone (516) 621-1025

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
007276-1NYMDPsychologist
007276NYMDAcupuncturist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1033104146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 GLENWOOD LN",
            "city": "ROSLYN HEIGHTS",
            "state": "NY",
            "postal_code": "115771411",
            "telephone_number": "516-621-1025",
            "fax_number": "516-621-3064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 GLENWOOD LN",
            "city": "ROSLYN HEIGHTS",
            "state": "NY",
            "postal_code": "115771411",
            "telephone_number": "516-621-1025",
            "fax_number": "516-621-3064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLDKLANG",
        "first_name": "STANLEY",
        "middle_name": "CURT",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-14",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "007276-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI PROVIDER NUMBER",
            "identifier": "0073403",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "077594",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MHN PROVIDER NUMBER",
            "identifier": "236510",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "V26521",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roslyn Heights, NY

Sources for this page

Verify at the official NPI Registry.