Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 529 | CT |
NPI | 1508196197 |
---|---|
Provider Name | Dr. Mark Goldenberg |
First Address | Weston, CT 06883-1309 |
Second Address | Weston, CT 06883-1309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2010 |
Last Update Date | 05/01/2010 |