Individual
MR. BRUCE GOLDENBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
21561
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005262100
—
MD
01
—
653CPH
MARYLAND PARTICIPATING PR
MD
01
—
N218
BLUECHOICE PROVIDER
MD
Enumeration date
11/05/2006
Last updated
09/19/2025
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