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General NPI Number Information
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NPI Number | 1588743041
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Entity Type | Individual
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Provider Name | WALTER CARL GOLDENBAUM DPM
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Gender | Male
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 424 E 138TH ST
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City | BRONX
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State | NY
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Zip | 10454-3002
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Country | US
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Telephone | 718-665-6116
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Fax |
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Provider Business Mailing Address
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Address Line | 228 SALOMONE AVE
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City | WEST PATERSON
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State | NJ
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Zip | 07424-3348
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Country | US
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Telephone | 973-925-8662
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | N004615
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License Number State | NY
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