Provider Demographics
NPI:1699015370
Name:GOLDENBERG, RAYA
Entity Type:Individual
Prefix:
First Name:RAYA
Middle Name:
Last Name:GOLDENBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 CLOCKTOWER DRIVE
Mailing Address - Street 2:APT. 4312
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02452
Mailing Address - Country:US
Mailing Address - Phone:617-721-4450
Mailing Address - Fax:
Practice Address - Street 1:132 CLOCKTOWER DR
Practice Address - Street 2:APT. 4312
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452-7873
Practice Address - Country:US
Practice Address - Phone:617-721-4450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-18
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN262356163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse