Provider Demographics
NPI:1801183033
Name:GOLDENBERG, KRISTINA (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:
Last Name:GOLDENBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 E 87TH ST
Mailing Address - Street 2:APT 10F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3240
Mailing Address - Country:US
Mailing Address - Phone:646-463-4122
Mailing Address - Fax:
Practice Address - Street 1:14 E 75TH ST # 1B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2625
Practice Address - Country:US
Practice Address - Phone:212-405-8202
Practice Address - Fax:212-405-8203
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY269057207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program