Provider Demographics
NPI:1326158460
Name:JORY GOLDBERG, MD PA
Entity Type:Organization
Organization Name:JORY GOLDBERG, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-655-1700
Mailing Address - Street 1:18 CENTRE DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MONROE TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-5153
Mailing Address - Country:US
Mailing Address - Phone:609-655-1700
Mailing Address - Fax:609-655-4455
Practice Address - Street 1:18 CENTRE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:MONROE TWP
Practice Address - State:NJ
Practice Address - Zip Code:08831-5153
Practice Address - Country:US
Practice Address - Phone:609-655-1700
Practice Address - Fax:609-655-4455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03688200207RC0200X
NJMA36882207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0428906Medicaid
NJ442370Medicare ID - Type Unspecified
NJD18812Medicare UPIN