Provider Demographics
NPI:1639482581
Name:GOLDMAN, RAIMONDA (DO)
Entity Type:Individual
Prefix:
First Name:RAIMONDA
Middle Name:
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:RAIMONDA
Other - Middle Name:
Other - Last Name:KOPELNITSKY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:718 TEANECK ROAD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-0000
Mailing Address - Country:US
Mailing Address - Phone:201-227-6008
Mailing Address - Fax:201-227-6002
Practice Address - Street 1:718 TEANECK ROAD
Practice Address - Street 2:REGIONAL CANCER CENTER
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-0000
Practice Address - Country:US
Practice Address - Phone:201-227-6008
Practice Address - Fax:201-227-6002
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08766800174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0241032Medicaid