Provider Demographics
NPI:1528001583
Name:GOLDBERG, DAVID J (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:250 OLD HOOK RD
Mailing Address - Street 2:3RD FLOOR LASER CENTER
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-3123
Mailing Address - Country:US
Mailing Address - Phone:201-594-9901
Mailing Address - Fax:201-358-3570
Practice Address - Street 1:20 PROSPECT AVE STE 702
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1974
Practice Address - Country:US
Practice Address - Phone:908-359-8980
Practice Address - Fax:201-441-9893
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2019-09-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY149959207ND0101X
FLME92597207ND0101X
NJ25MA04329300207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE13266Medicare UPIN