Provider Demographics
NPI:1407841638
Name:GOLDBERG, JORY J (MD)
Entity Type:Individual
Prefix:
First Name:JORY
Middle Name:J
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:08831-1501
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:08831-1501
Practice Address - Country:US
Practice Address - Phone:609-655-1700
Practice Address - Fax:609-655-4455
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA36882207R00000X, 207RP1001X
NJ25MA03688200207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0428906Medicaid
NJ0428906Medicaid
NJD18812Medicare UPIN
NJ442370AT2Medicare PIN