1639482581 NPI number — RAIMONDA GOLDMAN D.O.

Table of content: RAIMONDA GOLDMAN D.O. (NPI 1639482581)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639482581 NPI number — RAIMONDA GOLDMAN D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOLDMAN
Provider First Name:
RAIMONDA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KOPELNITSKY
Provider Other First Name:
RAIMONDA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1639482581
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
718 TEANECK ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEANECK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07666-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-227-6008
Provider Business Mailing Address Fax Number:
201-227-6002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
718 TEANECK ROAD
Provider Second Line Business Practice Location Address:
REGIONAL CANCER CENTER
Provider Business Practice Location Address City Name:
TEANECK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07666-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-227-6008
Provider Business Practice Location Address Fax Number:
201-227-6002
Provider Enumeration Date:
07/21/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  25MB08766800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0241032 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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