1780628362 NPI number — DR. ROBERT GOLDBERG M.D.

Table of content: DR. ROBERT GOLDBERG M.D. (NPI 1780628362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780628362 NPI number — DR. ROBERT GOLDBERG M.D.

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780628362
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 ESQUIRE RD
Provider Second Line Business Mailing Address:
SUITE 6
Provider Business Mailing Address City Name:
NEW CITY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10956-3336
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-634-2727
Provider Business Mailing Address Fax Number:
845-634-2882

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 ESQUIRE RD
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
NEW CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10956-3336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-634-2727
Provider Business Practice Location Address Fax Number:
845-634-2882
Provider Enumeration Date:
06/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  143731 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00995455 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P1964971 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0M081P . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1Z7862 . This is a "BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4202054 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4362 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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