Provider Demographics
NPI:1376007583
Name:GOLDBERG, SIGAL ALEXANDRA (PHARMD)
Entity Type:Individual
Prefix:
First Name:SIGAL
Middle Name:ALEXANDRA
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 IRIS ST
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-2610
Mailing Address - Country:US
Mailing Address - Phone:516-578-9339
Mailing Address - Fax:
Practice Address - Street 1:11 IRIS ST
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-2610
Practice Address - Country:US
Practice Address - Phone:516-578-9339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063710183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist