Provider Demographics
NPI:1508407404
Name:GOLDBERG, CAROLINE TYLER (AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:TYLER
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 N 5TH ST APT E617
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11249-3426
Mailing Address - Country:US
Mailing Address - Phone:714-797-0777
Mailing Address - Fax:
Practice Address - Street 1:520 E 70TH ST # STREET4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-9800
Practice Address - Country:US
Practice Address - Phone:646-962-5558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2019051799363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology