Provider Demographics
NPI:1689894206
Name:GOLDENBERG, DIANA (MD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:GOLDENBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 MAPLE AVE
Mailing Address - Street 2:SUITE G -1
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-4710
Mailing Address - Country:US
Mailing Address - Phone:914-683-0443
Mailing Address - Fax:914-683-8620
Practice Address - Street 1:170 MAPLE AVE
Practice Address - Street 2:SUITE G -1
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4710
Practice Address - Country:US
Practice Address - Phone:914-683-0443
Practice Address - Fax:914-683-8620
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237799207RR0500X
NY237799-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine