Provider Demographics
NPI:1457711012
Name:GOLDEMBERG, ABRA JACOBS (MSED)
Entity Type:Individual
Prefix:
First Name:ABRA
Middle Name:JACOBS
Last Name:GOLDEMBERG
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:ABRA
Other - Middle Name:
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED
Mailing Address - Street 1:57 GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-2401
Mailing Address - Country:US
Mailing Address - Phone:917-974-7548
Mailing Address - Fax:
Practice Address - Street 1:57 GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-2401
Practice Address - Country:US
Practice Address - Phone:917-974-7548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist