Individual provider Active NPI

Stephanie Ellen Golub, M.A. C.C.C.

  • Speech-Language Pathologist
  • Brooklyn, NY
National Provider Identifier
1083035265
Registry record updated Dec 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
002782 Issued in NY
Practice address
567 Kingston Ave
Brooklyn, NY 11203-1707
Phone
(718) 498-2500
Fax
(718) 778-4018
NPI assigned
Dec 14, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 002782 NY Primary

Addresses

Primary practice location

567 Kingston Ave
Brooklyn, NY 11203-1707

Mailing address

567 Kingston Ave
Brooklyn, NY 11203-1707
Phone (718) 498-2500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Arts

NPI Registry JSON

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

{
    "created_epoch": "1386979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386979200000",
    "number": "1083035265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "567 KINGSTON AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112031707",
            "telephone_number": "718-498-2500",
            "fax_number": "718-778-4018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "567 KINGSTON AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112031707",
            "telephone_number": "718-498-2500",
            "fax_number": "718-778-4018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLUB",
        "first_name": "STEPHANIE",
        "middle_name": "ELLEN",
        "name_prefix": "Mrs.",
        "credential": "M.A. C.C.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-12-14",
        "last_updated": "2013-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "002782",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.