Provider Demographics
NPI:1215456355
Name:GOLDBURD, AHUVA (SLP)
Entity type:Individual
Prefix:
First Name:AHUVA
Middle Name:
Last Name:GOLDBURD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 CANARY DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5453
Mailing Address - Country:US
Mailing Address - Phone:917-903-0667
Mailing Address - Fax:
Practice Address - Street 1:95 CANARY DR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5453
Practice Address - Country:US
Practice Address - Phone:917-903-0667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00645200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ41YS00645200OtherNJ STATE LICENSE