MEDICARE: SVETLANA GOLDENBERG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	040966	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	507092001	OTHER	NY	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487983821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SVETLANA GOLDENBERG

Provider Business Mailing Address
First Line	:	250 KINGS HWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-1205
Country	:	US
Telephone Number	:	718-946-6899
Fax Number	:	718-946-2743

Provider Business Practice Location Address
First Line	:	250 KINGS HWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-1205
Country	:	US
Telephone Number	:	718-946-6899
Fax Number	:	718-946-2743

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2009
Last Update Date	:	03/03/2015

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Directions to “ SVETLANA GOLDENBERG ” Practice Location

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