Provider Demographics
NPI:1093772683
Name:GOLDBERG, JOSEPH G (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:G
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E NEWPORT PIKE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19804-1920
Mailing Address - Country:US
Mailing Address - Phone:302-999-1286
Mailing Address - Fax:302-999-1162
Practice Address - Street 1:801 E NEWPORT PIKE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19804-1920
Practice Address - Country:US
Practice Address - Phone:302-999-1286
Practice Address - Fax:302-999-1162
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEI30001134152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCNV1667OtherMID ATLANTIC
DE510291543OtherUNITEDHEALTHCARE
DE4365417OtherAETNA
DE4365417OtherAETNA
DE037833G86Medicare PIN
DE510291543OtherUNITEDHEALTHCARE