Provider Demographics
NPI:1871635656
Name:GOLDMAN, RIVKA
Entity Type:Individual
Prefix:MRS
First Name:RIVKA
Middle Name:
Last Name:GOLDMAN
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 1:2101 SOLLY AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-2804
Mailing Address - Country:US
Mailing Address - Phone:215-745-1996
Mailing Address - Fax:215-745-1996
Practice Address - Street 1:2101 SOLLY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-2804
Practice Address - Country:US
Practice Address - Phone:215-745-1996
Practice Address - Fax:215-745-1996
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician