Provider Demographics
NPI:1033106927
Name:GOLDBERG, HOWARD S (MD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:S
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 ESTATE DR
Mailing Address - Street 2:
Mailing Address - City:FALLSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12733-5038
Mailing Address - Country:US
Mailing Address - Phone:845-434-4748
Mailing Address - Fax:845-434-4748
Practice Address - Street 1:10 ESTATE DR
Practice Address - Street 2:
Practice Address - City:FALLSBURG
Practice Address - State:NY
Practice Address - Zip Code:12733
Practice Address - Country:US
Practice Address - Phone:845-434-4748
Practice Address - Fax:845-434-4748
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275903207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE05169Medicare UPIN
CAG46667Medicare ID - Type Unspecified