Provider Demographics
NPI:1184629719
Name:GOLDBERG, JOEL B (OD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:B
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:JOEL
Other - Middle Name:B
Other - Last Name:GOLDBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2 CAMBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-1305
Mailing Address - Country:US
Mailing Address - Phone:845-362-3538
Mailing Address - Fax:
Practice Address - Street 1:2 CAMBRIDGE RD
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-1305
Practice Address - Country:US
Practice Address - Phone:845-362-3538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT004362-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01123124Medicaid
T84898Medicare UPIN
NY01123124Medicaid