Provider Demographics
NPI:1063765808
Name:GOLDIN, YELENA (PHD)
Entity type:Individual
Prefix:DR
First Name:YELENA
Middle Name:
Last Name:GOLDIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:YELENA
Other - Middle Name:
Other - Last Name:GOLDIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2048 OAK TREE RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2012
Mailing Address - Country:US
Mailing Address - Phone:732-906-2640
Mailing Address - Fax:732-906-9241
Practice Address - Street 1:2048 OAK TREE RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2012
Practice Address - Country:US
Practice Address - Phone:732-906-2640
Practice Address - Fax:732-906-9241
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-17
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00501500103G00000X
NY019165103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist