Provider Demographics
NPI:1689621955
Name:GOLDENBERG, STEVEN EMIL (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:EMIL
Last Name:GOLDENBERG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 HARRISON STREET
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790
Mailing Address - Country:US
Mailing Address - Phone:607-729-5016
Mailing Address - Fax:607-729-7574
Practice Address - Street 1:48 HARRISON STREET
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790
Practice Address - Country:US
Practice Address - Phone:607-729-5016
Practice Address - Fax:607-729-7574
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT0061001152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
M77405Medicare UPIN
CC1077Medicare ID - Type Unspecified
0834230003Medicare NSC