Martin Jay Golloub, LCSW, BCD

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

PR014204-1 Issued in NY

Practice address

66 Sugar Maple LN
Glen Cove, NY 11542-1632

Phone

(516) 676-3830

Fax

(516) 759-9503

NPI assigned

Oct 17, 2008

Sex

Male

Sole proprietor

Yes

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

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

Specialty

Clinical Social Worker

Education

Other, 1973

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1224201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1224201600000",
    "number": "1659523926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "66 SUGAR MAPLE LN",
            "city": "GLEN COVE",
            "state": "NY",
            "postal_code": "115421632",
            "telephone_number": "516-676-3830",
            "fax_number": "516-759-9503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "66 SUGAR MAPLE LN",
            "city": "GLEN COVE",
            "state": "NY",
            "postal_code": "115421632",
            "telephone_number": "516-676-3830",
            "fax_number": "516-759-9503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLLOUB",
        "first_name": "MARTIN",
        "middle_name": "JAY",
        "credential": "LCSW, BCD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-10-17",
        "last_updated": "2008-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "PR014204-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Glengariff Operating LLC
• Florin Vasile Glodan, MD
• Mary E Gola Perez, PA
• Wendy Ellen Goldenberg, RD
• Jake Goldstein
• Alejo Gomez, MD
• Ashley Annabelle Gonsalves, MD
• Melissa Sue Gonzalez-Vazquez, MSW,CASAC
• Mark Goodstein, MD
• Michael Gordon, MD

• Clinical Social Worker in Glen Cove, NY
• Providers in Glen Cove, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2008; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.