Provider Demographics
NPI:1609275288
Name:GOLD, ELISHEVA (SLP)
Entity type:Individual
Prefix:
First Name:ELISHEVA
Middle Name:
Last Name:GOLD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:ELISHEVA
Other - Middle Name:
Other - Last Name:HOFFMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1000 MONMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-1923
Mailing Address - Country:US
Mailing Address - Phone:646-705-3124
Mailing Address - Fax:
Practice Address - Street 1:1000 MONMOUTH AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-1923
Practice Address - Country:US
Practice Address - Phone:646-705-3124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
NJ41YS00847300235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist