1861519910 NPI number — DON L. GOLDENBERG MD PC

Table of content: (NPI 1861519910)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861519910 NPI number — DON L. GOLDENBERG MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DON L. GOLDENBERG MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861519910
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 848740
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02284-8740
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-243-5440
Provider Business Mailing Address Fax Number:
617-243-6453

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02462-1650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-243-5440
Provider Business Practice Location Address Fax Number:
617-243-6453
Provider Enumeration Date:
03/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GOLDENBERG
Authorized Official First Name:
DON
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
617-243-5440

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  34653 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 034653 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 25022 . This is a "HARVARD PILGRIM HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9757562 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: M14823 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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