Provider Demographics
NPI:1205816774
Name:GOLDBERG, LESLIE P (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:P
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2110 NORTHERN BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3502
Mailing Address - Country:US
Mailing Address - Phone:516-627-5113
Mailing Address - Fax:516-365-2817
Practice Address - Street 1:2110 NORTHERN BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3502
Practice Address - Country:US
Practice Address - Phone:516-627-5113
Practice Address - Fax:516-365-2817
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY109382207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C07933Medicare UPIN
292441Medicare ID - Type Unspecified