Provider Demographics
NPI:1477619385
Name:GOLDUBER, VICTORIA (OT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:GOLDUBER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:RIVKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:1075 SEAWANE DR
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-2605
Mailing Address - Country:US
Mailing Address - Phone:917-685-5168
Mailing Address - Fax:
Practice Address - Street 1:2952 BRIGHTON 3RD ST STE 202
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7078
Practice Address - Country:US
Practice Address - Phone:718-975-4334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0485BDMedicare UPIN