Provider Demographics
NPI:1316034002
Name:GOLDBERGER, MICHAEL
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:GOLDBERGER
Suffix:
Gender:M
Credentials:
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 1446
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07962-1446
Mailing Address - Country:US
Mailing Address - Phone:973-538-2334
Mailing Address - Fax:973-538-4081
Practice Address - Street 1:160 HANOVER AVENUE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07962
Practice Address - Country:US
Practice Address - Phone:973-538-2334
Practice Address - Fax:973-538-4081
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06769800174400000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ200033841OtherRAILROAD MEDICARE #
NJ2059451OtherAETNA HMO #
NJ223014220OtherTAX ID#
NJP1024733OtherOXFORD #
NJ0787597000OtherAMERIHEALTH #
NJ5222661OtherAETNA PPO#
NJ7697601Medicaid
NJB60824OtherAMERIHEALTH ADM #
NJ5713655OtherGHI PPO #
NJ0787597000OtherAMERIHEALTH #
NJP1024733OtherOXFORD #