Provider Demographics
NPI:1043532161
Name:DAVID M. GOLDBERG, PH.D., P.A.
Entity Type:Organization
Organization Name:DAVID M. GOLDBERG, PH.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:732-576-8925
Mailing Address - Street 1:34 SYCAMORE AVE
Mailing Address - Street 2:BUILDING 2
Mailing Address - City:LITTLE SILVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07739-1228
Mailing Address - Country:US
Mailing Address - Phone:732-576-8925
Mailing Address - Fax:732-576-8814
Practice Address - Street 1:34 SYCAMORE AVE
Practice Address - Street 2:BUILDING 2
Practice Address - City:LITTLE SILVER
Practice Address - State:NJ
Practice Address - Zip Code:07739-1228
Practice Address - Country:US
Practice Address - Phone:732-576-8925
Practice Address - Fax:732-576-8814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00345400103TC0700X
NJ44SC054134001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty