Provider Demographics
NPI:1992294615
Name:GOLUB, SARA ROSE (MS)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ROSE
Last Name:GOLUB
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 ROBERTA LN
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-2854
Mailing Address - Country:US
Mailing Address - Phone:516-526-6248
Mailing Address - Fax:
Practice Address - Street 1:1831 ROBERTA LN
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-2854
Practice Address - Country:US
Practice Address - Phone:516-526-6248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty