Healthcare Provider Details

I. General information

NPI: 1801064720
Provider Name (Legal Business Name): CINDY LARA GOLDBERG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2008
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 CONNECTICUT AVE
NORWALK CT
06854-1525
US

IV. Provider business mailing address

120 CONNECTICUT AVE
NORWALK CT
06854-1525
US

V. Phone/Fax

Practice location:
  • Phone: 203-899-1770
  • Fax: 203-899-1769
Mailing address:
  • Phone: 203-899-1770
  • Fax: 203-899-1769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number046160
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number046160
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: