Individual
PENINA GOLOMBECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
215 PASSAIC AVE APT 3H, PASSAIC, NJ 07055-3606
(973) 803-0291
Mailing address
215 PASSAIC AVE APT 3H, PASSAIC, NJ 07055-3606
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
024724
—
NY
Enumeration date
05/10/2020
Last updated
05/10/2020
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