Provider Demographics
NPI:1235167768
Name:GOLDBERG, EDWARD S (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:S
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 1:121 EAST 60TH STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022
Mailing Address - Country:US
Mailing Address - Phone:212-980-8800
Mailing Address - Fax:212-980-8807
Practice Address - Street 1:121 EAST 60TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022
Practice Address - Country:US
Practice Address - Phone:212-980-8800
Practice Address - Fax:212-980-8807
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185376207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY185376OtherHIP
NY1056239001OtherUNITED HEALTHCARE
NY4345864OtherAETNA
NY37H521OtherBLUE CROSS BLUE SHIELD
NYNZ0227OtherHEALTHNET
NY2485896OtherAETNA SPECIALITS
NYNS3229OtherOXFORD
NY4345864OtherAETNA
NYE53597Medicare UPIN