Active NPI
Walter Carl Goldenbaum, DPM
- Podiatrist
- Bronx, NY
National Provider Identifier
1588743041
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- N004615
- Practice address
- 424 E 138TH St
Bronx, NY 10454-3002 - Phone
- (718) 665-6116
- NPI assigned
- Nov 3, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | N004615 | NY | Primary |
Addresses
Primary practice location
424 E 138TH St
Bronx, NY 10454-3002
Mailing address
228 Salomone Ave
West Paterson, NJ 07424-3348
Phone (973) 925-8662
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01197442 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 004615 | NY | MD | Registered Dietitian |
| N004615 | NY | MD | Podiatrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Angeles Physical Therapy PC | Past | Accepting new patients | |
| Weill Medical College of Cornell University | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapy Clinic/Center
- New York, NY
- NPI 1437931375
-
dba Cornell University Medical
- Ophthalmology Physician
- New York, NY
- NPI 1790801074
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162512000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1588743041",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "228 SALOMONE AVE",
"city": "WEST PATERSON",
"state": "NJ",
"postal_code": "074243348",
"telephone_number": "973-925-8662"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "424 E 138TH ST",
"city": "BRONX",
"state": "NY",
"postal_code": "104543002",
"telephone_number": "718-665-6116"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOLDENBAUM",
"first_name": "WALTER",
"middle_name": "CARL",
"name_prefix": "Dr.",
"credential": "DPM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-03",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "NY",
"license": "N004615",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01197442",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.