Basic Information
| Provider Information | |||||||||
| NPI: | 1740677855 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOLDENBERG | ||||||||
| FirstName: | ALICIA | ||||||||
| MiddleName: | VIVIAN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 37 CLIFFSIDE DR. | ||||||||
| Address2: | |||||||||
| City: | TORONTO | ||||||||
| State: | ONTARIO | ||||||||
| PostalCode: | M1N 1K9 | ||||||||
| CountryCode: | CA | ||||||||
| TelephoneNumber: | 6478323202 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | ELM AND CARLTON STREETS | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168452300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2015 | ||||||||
| LastUpdateDate: | 05/14/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | NJ | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207ZD0900X | 304150 | NY | Y | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology |
No ID Information.