Provider Demographics
NPI:1346324548
Name:GOLDBERG, HENRY (MA, OTR, CHT)
Entity Type:Individual
Prefix:MR
First Name:HENRY
Middle Name:
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:MA, OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W 80TH ST APT 10E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-7144
Mailing Address - Country:US
Mailing Address - Phone:917-723-2248
Mailing Address - Fax:
Practice Address - Street 1:1505 WIGWAM PKWY
Practice Address - Street 2:SUITE 240
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-8194
Practice Address - Country:US
Practice Address - Phone:702-568-0195
Practice Address - Fax:702-568-0365
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000727-1225XH1200X
NV16-0817225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand