Active NPI
Robin Goldenback
- Speech-Language Pathologist
- Saint Albans, NY
National Provider Identifier
1427592971
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 003894-1
- Practice address
- 10936 204TH St
Saint Albans, NY 11412-1326 - Phone
- (718) 465-8310
- Fax
- (718) 465-3939
- NPI assigned
- Dec 16, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 003894-1 | NY | Primary |
Addresses
Primary practice location
10936 204TH St
Saint Albans, NY 11412-1326
Mailing address
109-36 204TH St.
P. 233@ 827
Hollis, NY 11412
Phone (718) 465-8310
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 003894-1 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1481846400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1481846400000",
"number": "1427592971",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "109-36 204TH ST.",
"address_2": "P. 233@ 827",
"city": "HOLLIS",
"state": "NY",
"postal_code": "11412",
"telephone_number": "718-465-8310",
"fax_number": "718-465-3939"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10936 204TH ST",
"city": "SAINT ALBANS",
"state": "NY",
"postal_code": "114121326",
"telephone_number": "718-465-8310",
"fax_number": "718-465-3939"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOLDENBACK",
"first_name": "ROBIN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-12-16",
"last_updated": "2016-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NY",
"license": "003894-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Albans, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.