MEDICARE: DR. WALTER CARL GOLDENBAUM DPM

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	213E00000X	Podiatrist	N004615	NY

Other Identifiers

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

General Provider Information

NPI Number	:	1588743041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WALTER CARL GOLDENBAUM DPM

Provider Business Mailing Address
First Line	:	228 SALOMONE AVE
Second Line	:
City	:	WEST PATERSON
State	:	NJ
Zip	:	07424-3348
Country	:	US
Telephone Number	:	973-925-8662
Fax Number	:

Provider Business Practice Location Address
First Line	:	424 E 138TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10454-3002
Country	:	US
Telephone Number	:	718-665-6116
Fax Number	:

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

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	07/09/2007

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