Provider Demographics
NPI:1477669356
Name:GOLDENBERG, PERRY ZOLMAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:PERRY
Middle Name:ZOLMAN
Last Name:GOLDENBERG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 S RIDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-1461
Mailing Address - Country:US
Mailing Address - Phone:973-378-3351
Mailing Address - Fax:
Practice Address - Street 1:3250 3RD AVE
Practice Address - Street 2:DOCTORS OFFICE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-6743
Practice Address - Country:US
Practice Address - Phone:718-328-3668
Practice Address - Fax:718-328-2952
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005140213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01540005Medicaid
NY01540005Medicaid
U53022Medicare UPIN