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General NPI Number Information
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NPI Number | 1487184800
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Entity Type | Organization
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Legal Business Name | FUNCDE, LLC
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Dates
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Enumeration Date | 06/18/2017
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Last Update Date | 04/22/2020
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Provider Practice Location Address
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Address Line | 969 READING RD STE N
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City | MASON
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State | OH
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Zip | 45040
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Country | US
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Telephone | 513-604-1004
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Fax | 513-437-0571
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Provider Business Mailing Address
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Address Line | 969 READING RD STE N
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City | MASON
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State | OH
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Zip | 45040-2654
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Country | US
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Telephone | 513-604-1004
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Fax | 513-437-0571
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | NAILA M GOLDENBERG
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Credential | MD
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Telephone | 513-604-1004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State | OH
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