| Functional Endocrinology | |
|
969 Reading Rd Ste N Mason OH 45040 | |
| (513) 604-1004 | |
| (513) 437-0571 |
| Full Name | Functional Endocrinology |
|---|---|
| Speciality | Internal Medicine |
| Location | 969 Reading Rd Ste N, Mason, Ohio |
| Authorized Official Name and Position | Naila M Goldenberg (PRACTICE OWNER) |
| Authorized Official Contact | 5136041004 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Functional Endocrinology 969 Reading Rd Ste N Mason OH 45040-2654 Ph: (513) 604-1004 | Functional Endocrinology 969 Reading Rd Ste N Mason OH 45040 Ph: (513) 604-1004 |
| NPI Number | 1487184800 |
|---|---|
| Provider Enumeration Date | 06/18/2017 |
| Last Update Date | 04/22/2020 |
| Medicare PECOS PAC ID | 2264704139 |
|---|---|
| Medicare Enrollment ID | O20170828002532 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487184800 | NPI | - | NPPES |
| 0079958 | Medicaid | OH | |
| 0233942 | Medicaid | OH | |
| 7100510650 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | (Ohio) | Primary |
| Provider Name | Naila M Goldenberg |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1396796330 PECOS PAC ID: 3072533058 Enrollment ID: I20070601000571 |
| Provider Name | Michael Spivak |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437499076 PECOS PAC ID: 6901041144 Enrollment ID: I20130318000388 |
| Provider Name | Teaera Roland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114468261 PECOS PAC ID: 1850666314 Enrollment ID: I20171009003443 |
| Provider Name | Jean E Taggart |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497465942 PECOS PAC ID: 6103297825 Enrollment ID: I20230117001411 |
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