1912986571 NPI number — JUDITH CAROL GOLDBERG-BERMAN M.D., PH.D

Table of content: JUDITH CAROL GOLDBERG-BERMAN M.D., PH.D (NPI 1912986571)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912986571 NPI number — JUDITH CAROL GOLDBERG-BERMAN M.D., PH.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOLDBERG-BERMAN
Provider First Name:
JUDITH
Provider Middle Name:
CAROL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D., PH.D
Provider Gender Code:
F

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:
1912986571
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
56 LAFAYETTE PL
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
GREENWICH
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06830-5430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-622-9160
Provider Business Mailing Address Fax Number:
203-661-3887

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
56 LAFAYETTE PL
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
GREENWICH
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06830-5430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-622-9160
Provider Business Practice Location Address Fax Number:
203-661-3887
Provider Enumeration Date:
01/12/2006

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: 174400000X , with the licence number:  033-952 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1912986571 . This is a "NPI" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com