Basic Information
| Provider Information | |||||||||
| NPI: | 1396796330 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOLDENBERG | ||||||||
| FirstName: | NAILA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 969 READING RD STE N | ||||||||
| Address2: | |||||||||
| City: | MASON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450402654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136041004 | ||||||||
| FaxNumber: | 5134370571 | ||||||||
| Practice Location | |||||||||
| Address1: | 969 READING RD STE N | ||||||||
| Address2: | |||||||||
| City: | MASON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450402654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136041004 | ||||||||
| FaxNumber: | 5134370571 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2006 | ||||||||
| LastUpdateDate: | 05/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35-079737 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RE0101X | 35-079737 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 7100045840 | 05 | KY | MEDICAID | 2757360 | 05 | OH | MEDICAID |