Provider Demographics
NPI:1326224502
Name:EDWARD M. GOLDBERG O.D.
Entity Type:Organization
Organization Name:EDWARD M. GOLDBERG O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:516-997-4887
Mailing Address - Street 1:7 MONTAUK CT
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-2725
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:516-997-8088
Practice Address - Street 1:7 MONTAUK CT
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-2725
Practice Address - Country:US
Practice Address - Phone:516-997-4887
Practice Address - Fax:516-997-8088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT002946-1332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0636960001Medicare NSC