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NPI Code Detail

MEDICARE: HENRY GOLDENBERG

MEDICARE: HENRY GOLDENBERG
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
11041C0700XClinical Social WorkerR030045-1NY

General Provider Information

NPI Number : 1659478717
Entity Type Code : Individual
Provider Name (Legal Business Name) : HENRY GOLDENBERG
Provider Business Mailing Address
First Line : 48 MACEY LN
Second Line :
City : PLATTSBURGH
State : NY
Zip : 12901-5922
Country : US
Telephone Number : 518-563-0758
Fax Number :
Provider Business Practice Location Address
First Line : 22 US OVAL
Second Line : SUITE 100
City : PLATTSBURGH
State : NY
Zip : 12903-5900
Country : US
Telephone Number : 518-561-1767
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 07/08/2007

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