Provider Demographics
NPI:1902373186
Name:GOLDENBERG, ALYSON MICHELE (NP)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:MICHELE
Last Name:GOLDENBERG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 W END AVE APT 7C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-2724
Mailing Address - Country:US
Mailing Address - Phone:310-963-0326
Mailing Address - Fax:
Practice Address - Street 1:545 W END AVE APT 7C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-2724
Practice Address - Country:US
Practice Address - Phone:310-963-0326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF343363363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily