Provider Demographics
NPI:1538168745
Name:GOLDENBERG, BRUCE S (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:S
Last Name:GOLDENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 377
Mailing Address - Street 2:
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078-0377
Mailing Address - Country:US
Mailing Address - Phone:973-467-5550
Mailing Address - Fax:973-467-9511
Practice Address - Street 1:1500 PLEASANT VALLEY WAY STE 206
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2956
Practice Address - Country:US
Practice Address - Phone:973-467-5550
Practice Address - Fax:973-467-9511
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA05016000208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0120405Medicaid
NJC45865Medicare UPIN
NJ0120405Medicaid