Provider Demographics
NPI:1629421870
Name:VENSON, GOLDERINA
Entity Type:Individual
Prefix:
First Name:GOLDERINA
Middle Name:
Last Name:VENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GOLDERINA
Other - Middle Name:
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26 JACKSON AVE
Mailing Address - Street 2:#2
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-1059
Mailing Address - Country:US
Mailing Address - Phone:917-295-2360
Mailing Address - Fax:
Practice Address - Street 1:7000 AUSTIN ST
Practice Address - Street 2:#200
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1022
Practice Address - Country:US
Practice Address - Phone:718-762-7633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist