Provider Demographics
NPI:1073505210
Name:GOLDBERG, ALLAN SETH (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:SETH
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MITCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-3019
Mailing Address - Country:US
Mailing Address - Phone:516-433-2562
Mailing Address - Fax:
Practice Address - Street 1:327 BEACH 19 STREET
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691
Practice Address - Country:US
Practice Address - Phone:718-869-7168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003242213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00764296Medicaid
NY05216Medicare ID - Type Unspecified
NY00764296Medicaid
NY6514WLMedicare PIN