Provider Demographics
NPI:1689619041
Name:GOLDENBERG, GIDON FEIVEL (MD)
Entity Type:Individual
Prefix:DR
First Name:GIDON
Middle Name:FEIVEL
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 1:100 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2365
Mailing Address - Country:US
Mailing Address - Phone:203-234-1891
Mailing Address - Fax:203-234-2678
Practice Address - Street 1:100 BROADWAY
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-2365
Practice Address - Country:US
Practice Address - Phone:203-234-1891
Practice Address - Fax:203-234-2678
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT027733207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT027733OtherCTCARE
CT110180190OtherRAILROAD MEDICARE
CT0478961OtherAETNA
CT061535742OtherUNITED HEALTHCARE
CTP498960OtherOXFORD
CT001277335Medicaid
CT0Q1460OtherHEALTHNET
CT01227733OtherCIGNA
CT010027733CT02OtherANTHEM BCBS
CT010027733CT02OtherANTHEM BCBS
CT027733OtherCTCARE