Provider Demographics
NPI:1083604680
Name:GOLDBERG, PABLO (MD)
Entity Type:Individual
Prefix:
First Name:PABLO
Middle Name:
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 1:1051 RIVERSIDE DRIVE
Mailing Address - Street 2:UNIT 74 2ND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032
Mailing Address - Country:US
Mailing Address - Phone:646-499-1456
Mailing Address - Fax:888-757-4699
Practice Address - Street 1:1051 RIVERSIDE DRIVE
Practice Address - Street 2:UNIT 74 2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:646-774-6318
Practice Address - Fax:888-757-4699
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT0432292084P0800X
NY2532092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1432294Medicaid
CT260004483Medicare PIN
CT1432294Medicaid