Provider Demographics
NPI:1194101477
Name:GOLDBRENNER, ELISHEVA (MS)
Entity type:Individual
Prefix:
First Name:ELISHEVA
Middle Name:
Last Name:GOLDBRENNER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 OCEAN PKWY
Mailing Address - Street 2:APT 3M
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-5154
Mailing Address - Country:US
Mailing Address - Phone:347-702-6137
Mailing Address - Fax:
Practice Address - Street 1:1225 OCEAN PKWY
Practice Address - Street 2:APT 3M
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-5154
Practice Address - Country:US
Practice Address - Phone:347-702-6137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY675981121174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist