Provider Demographics
NPI:1467540120
Name:GOLDBERG, STANLEY JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:JOSEPH
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 1:1045 ATLANTIC AVE
Mailing Address - Street 2:SUITE 1002
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-3408
Mailing Address - Country:US
Mailing Address - Phone:562-435-5511
Mailing Address - Fax:562-435-7503
Practice Address - Street 1:1045 ATLANTIC AVE
Practice Address - Street 2:SUITE 1002
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3408
Practice Address - Country:US
Practice Address - Phone:562-435-5511
Practice Address - Fax:562-435-7503
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG29263208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G292630Medicaid
CA00G292630Medicaid
CAW13456Medicare ID - Type Unspecified