Provider Demographics
NPI:1538477831
Name:GOLDENBERG, RIVA (MD)
Entity Type:Individual
Prefix:
First Name:RIVA
Middle Name:
Last Name:GOLDENBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 AVENUE T
Mailing Address - Street 2:APT 4G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3458
Mailing Address - Country:US
Mailing Address - Phone:917-816-5452
Mailing Address - Fax:
Practice Address - Street 1:221 PARKVILLE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-1373
Practice Address - Country:US
Practice Address - Phone:718-236-1222
Practice Address - Fax:718-236-5829
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY258052207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine