Provider Demographics
NPI:1316019003
Name:GOLDBERG, ROBIN H (MD)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:H
Last Name:GOLDBERG
Suffix:
Gender:F
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:PO BOX 117
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-0117
Mailing Address - Country:US
Mailing Address - Phone:914-472-4610
Mailing Address - Fax:914-241-6932
Practice Address - Street 1:ONE PONDFIELD WEST SUITE 2
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-2648
Practice Address - Country:US
Practice Address - Phone:914-472-4610
Practice Address - Fax:914-241-6932
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223781207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02633094Medicaid
NY02633094Medicaid
NY76S411Medicare ID - Type Unspecified