1205839255 NPI number — DR. STEVEN M GOLDBERG M.D.

Employer Identification Number (EIN)	:
Provider Organization Name (Legal Business Name)	:
Provider Last Name (Legal Name)	:	GOLDBERG
Provider First Name	:	STEVEN
Provider Middle Name	:	M
Provider Name Prefix Text	:	DR.
Provider Name Suffix Text	:
Provider Credential Text	:	M.D.
Provider Gender Code	:	M

Provider Other Organization Name	:
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Provider Other Last Name	:
Provider Other First Name	:
Provider Other Middle Name	:
Provider Other Name Prefix Text	:
Provider Other Name Suffix Text	:
Provider Other Credential Text	:
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NPI Number	:	1205839255
Entity Type Code	:	Individual
Replacement NPI	:
Last Update Date	:	04/04/2011
NPI Deactivation Reason Code	:
NPI Deactivation Date	:
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Provider First Line Business Mailing Address	:	1010 NORTHERN BLVD
Provider Second Line Business Mailing Address	:	STE 110
Provider Business Mailing Address City Name	:	GREAT NECK
Provider Business Mailing Address State Name	:	NY
Provider Business Mailing Address Postal Code	:	110215306
Provider Business Mailing Address Country Code	:	US
Provider Business Mailing Address Telephone Number	:	5163902430
Provider Business Mailing Address Fax Number	:	5164827955

Provider First Line Business Practice Location Address	:	1010 NORTHERN BLVD
Provider Second Line Business Practice Location Address	:	STE 110
Provider Business Practice Location Address City Name	:	GREAT NECK
Provider Business Practice Location Address State Name	:	NY
Provider Business Practice Location Address Postal Code	:	110215306
Provider Business Practice Location Address Country Code	:	US
Provider Business Practice Location Address Telephone Number	:	5163902430
Provider Business Practice Location Address Fax Number	:	5164827955
Provider Enumeration Date	:	05/23/2005

Authorized Official Last Name	:
Authorized Official First Name	:
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• Taxonomy code: 207RC0000X , with the licence number:  144482 , registered in the state of NY .

• Identifier: C06133 , issued by the state of ( NY ) . This identifiers is of the category "".
• Identifier: SG016D6410 . This is a "MEDICARE PROVIDER" identifier , issued by the state of ( NY ) . This identifiers is of the category "".