Provider Demographics
NPI:1437436649
Name:MARK GOLDBERG PROSTHETIC & ORTHOTIC LABS, INC.
Entity Type:Organization
Organization Name:MARK GOLDBERG PROSTHETIC & ORTHOTIC LABS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:631-689-6606
Mailing Address - Street 1:9 TECHNOLOGY DR
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-4000
Mailing Address - Country:US
Mailing Address - Phone:631-689-6606
Mailing Address - Fax:
Practice Address - Street 1:2545 HEMPSTEAD TPKE
Practice Address - Street 2:SUITE 305
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-2194
Practice Address - Country:US
Practice Address - Phone:631-689-6606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-16
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier