Provider Demographics
NPI:1285039941
Name:GOLDBURD, ERIC (LAC)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:GOLDBURD
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 LEE ST
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407-2706
Mailing Address - Country:US
Mailing Address - Phone:201-606-3071
Mailing Address - Fax:
Practice Address - Street 1:9922 ROOSEVELT BLVD
Practice Address - Street 2:ALLIANCE PHYSICIAN ASSOCIATION BUILDING
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-1705
Practice Address - Country:US
Practice Address - Phone:267-403-3085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00108400171100000X
NY005364-1171100000X
PAAK00150171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist