Provider Demographics
NPI:1316926330
Name:GOLDENBERG, ALEC S (MD)
Entity type:Individual
Prefix:
First Name:ALEC
Middle Name:S
Last Name:GOLDENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:157 EAST 32ND STREET
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6028
Mailing Address - Country:US
Mailing Address - Phone:212-689-6791
Mailing Address - Fax:212-689-7059
Practice Address - Street 1:157 EAST 32ND STREET
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6028
Practice Address - Country:US
Practice Address - Phone:212-689-6791
Practice Address - Fax:212-689-7059
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY60-157737207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENS3824OtherOXFORD FREEDOM GROUP
NY12216POtherHIP
NY577842OtherAETNA
A60899Medicare UPIN
NY577842OtherAETNA