Provider Demographics
NPI:1881828127
Name:GOLDENBERG, TROY JOSEPH (LAC)
Entity type:Individual
Prefix:MR
First Name:TROY
Middle Name:JOSEPH
Last Name:GOLDENBERG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 NE PALM AVE
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-5246
Mailing Address - Country:US
Mailing Address - Phone:772-453-1072
Mailing Address - Fax:772-453-1072
Practice Address - Street 1:1635 NE JENSEN BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-7229
Practice Address - Country:US
Practice Address - Phone:772-453-1072
Practice Address - Fax:772-510-4229
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-14
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12823171100000X
FLAP4520171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist