Provider Demographics
NPI:1407827199
Name:GOLDBERG, JEFFREY (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:666 PLAINSBORO RD
Mailing Address - Street 2:STE 1330
Mailing Address - City:PLAINSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08536
Mailing Address - Country:US
Mailing Address - Phone:609-799-3303
Mailing Address - Fax:609-799-9619
Practice Address - Street 1:666 PLAINSBORO RD
Practice Address - Street 2:STE 1330
Practice Address - City:PLAINSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08536
Practice Address - Country:US
Practice Address - Phone:609-799-3303
Practice Address - Fax:609-799-9619
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4774152W00000X
NJ00095152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2142902Medicaid
NJG0441319Medicare ID - Type Unspecified
NJ2142902Medicaid