Healthcare Provider Details

I. General information

NPI: 1841293842
Provider Name (Legal Business Name): JOEL M GOLDENBERG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 HEMPSTEAD TPKE
FRANKLIN SQUARE NY
11010-4334
US

IV. Provider business mailing address

15 DELL DR
EAST ROCKAWAY NY
11518-2107
US

V. Phone/Fax

Practice location:
  • Phone: 516-565-6565
  • Fax:
Mailing address:
  • Phone: 516-650-2417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number050103
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: