Provider Demographics
NPI:1063432680
Name:GOLDENBERG, ELIE A (MD)
Entity type:Individual
Prefix:
First Name:ELIE
Middle Name:A
Last Name:GOLDENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2063 KLOCKNER ROAD
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690
Mailing Address - Country:US
Mailing Address - Phone:609-631-1001
Mailing Address - Fax:609-588-5970
Practice Address - Street 1:2063 KLOCKNER RD FL 1
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690-3414
Practice Address - Country:US
Practice Address - Phone:609-631-1001
Practice Address - Fax:609-588-5970
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233552208600000X
GA055362208600000X
NH13284208600000X
NJ25MA10014800208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30206921Medicaid
NH000154202Medicare PIN