Healthcare Provider Details

I. General information

NPI: 1538168745
Provider Name (Legal Business Name): BRUCE S. GOLDENBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 PLEASANT VALLEY WAY STE 206
WEST ORANGE NJ
07052-2956
US

IV. Provider business mailing address

PO BOX 377
SHORT HILLS NJ
07078-0377
US

V. Phone/Fax

Practice location:
  • Phone: 973-467-5550
  • Fax: 973-467-9511
Mailing address:
  • Phone: 973-467-5550
  • Fax: 973-467-9511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number25MA05016000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: