Provider Demographics
NPI:1538100185
Name:GOLDBERG, NEIL ELLIS (DPM)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:ELLIS
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 WASHINGTON CT
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-2118
Mailing Address - Country:US
Mailing Address - Phone:973-535-9060
Mailing Address - Fax:
Practice Address - Street 1:228 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-2202
Practice Address - Country:US
Practice Address - Phone:973-762-9060
Practice Address - Fax:973-762-5056
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00103900213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0857602Medicaid
NJ131100Medicare ID - Type Unspecified
NJT77739Medicare UPIN