Shelly Ellen Goldklank, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

7275 Issued in NY

Practice address

740 West End Avenue
New York, NY 10025-6248

Phone

(212) 666-7004

NPI assigned

Feb 14, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Apr 27, 2022 through Apr 27, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Goldklank & Fulmer Psychological Services PC

  • Psychologist
  • New York, NY
  • NPI 1083984090
  NPD (past)

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

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1336435200000",
    "number": "1154464030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "740 WEST END AVENUE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100256248",
            "telephone_number": "212-666-7004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "740 WEST END AVENUE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100256248",
            "telephone_number": "212-666-7004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLDKLANK",
        "first_name": "SHELLY",
        "middle_name": "ELLEN",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-14",
        "last_updated": "2012-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "7275",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lenore F Golding, MS, OTR/L
• Yaakov Golding, P.T.
• Arielle R Goldklang, PSY. D.
• Monica P Goldklang, M.D.
• Goldklank & Fulmer Psychological Services PC
• Diane Goldkopf, PH.D
• Ian Scott Goldlust, MD, PHD
• Sandra Michelle Goldlust, MD
• Goldman Dermatology, PLLC
• Nadya Goldman Dunay

• Clinical Psychologist in New York, NY
• Providers in New York, NY by specialty
• Clinical Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.