Healthcare Provider Details

I. General information

NPI: 1114186418
Provider Name (Legal Business Name): NEAL E GOLDENBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2008
Last Update Date: 08/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1744 PAYNE AVENUE
CLEVELAND OH
44114
US

IV. Provider business mailing address

1744 PAYNE AVENUE
CLEVELAND OH
44114
US

V. Phone/Fax

Practice location:
  • Phone: 216-623-6555
  • Fax: 216-623-6539
Mailing address:
  • Phone: 216-623-6555
  • Fax: 216-623-6539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35.120855
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: