Provider Demographics
NPI:1619977642
Name:GOLDENBERG, SAMUEL F (MD/)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:F
Last Name:GOLDENBERG
Suffix:
Gender:M
Credentials:MD/
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 E EVESHAM RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-9590
Mailing Address - Country:US
Mailing Address - Phone:856-673-1615
Mailing Address - Fax:856-424-7621
Practice Address - Street 1:2401 E EVESHAM RD
Practice Address - Street 2:SUITE F
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-9590
Practice Address - Country:US
Practice Address - Phone:856-673-1615
Practice Address - Fax:856-424-7621
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA056572208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4601505Medicaid
NJE95085Medicare UPIN
NJ681167DKLMedicare ID - Type Unspecified