Provider Demographics
NPI:1104859669
Name:JOEL GOLDBERG MD PC
Entity Type:Organization
Organization Name:JOEL GOLDBERG MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:ARONSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-829-9550
Mailing Address - Street 1:310 E SHORE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-2432
Mailing Address - Country:US
Mailing Address - Phone:516-829-9550
Mailing Address - Fax:516-829-9718
Practice Address - Street 1:310 E SHORE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-2432
Practice Address - Country:US
Practice Address - Phone:516-829-9550
Practice Address - Fax:516-829-9718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW21791Medicare ID - Type Unspecified