Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 207101 | NY |
Y | 111NI0900X | Internist | 207101 | NY |
N | 207RG0300X | Geriatric Medicine | 207101 | NY |
N | 207RH0002X | Hospice and Palliative Medicine | 207101 | NY |
NPI | 1093784837 |
---|---|
Provider Name | Grigoriy Goldenberg |
First Address | Bayside, NY 11360-1826 |
Second Address | Brooklyn, NY 11229-4730 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2006 |
Last Update Date | 15/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01862871 | (05) | NY |
G63448 | (02) |