MEDICARE: TRADITIONAL AND ALTERNATIVE MEDICINE PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	207101	NY

General Provider Information

NPI Number	:	1346468139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRADITIONAL AND ALTERNATIVE MEDICINE PC

Provider Business Mailing Address
First Line	:	20939 23RD AVE APT 2E
Second Line	:
City	:	BAYSIDE
State	:	NY
Zip	:	11360-1831
Country	:	US
Telephone Number	:	718-224-5935
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 W END AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-4848
Country	:	US
Telephone Number	:	718-332-5268
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GRIGORIY GOLDENBERG
Credential	:
Telephone Number	:	917-692-8241

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	08/22/2020

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