Provider Demographics
NPI:1588601793
Name:JOSEPHBERG, ROBERT GARY (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GARY
Last Name:JOSEPHBERG
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 1:11 TANGLEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:BRIARCLIFF MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10510-2551
Mailing Address - Country:US
Mailing Address - Phone:914-923-2392
Mailing Address - Fax:914-965-2527
Practice Address - Street 1:984 NORTH BROADWAY
Practice Address - Street 2:SUITE 511
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1308
Practice Address - Country:US
Practice Address - Phone:914-965-2526
Practice Address - Fax:914-965-2527
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ33921174400000X
NY134320174400000X, 207W00000X, 207WX0108X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No174400000XOther Service ProvidersSpecialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0108XAllopathic & Osteopathic PhysiciansOphthalmologyUveitis and Ocular Inflammatory Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00887554Medicaid
NJ1038109Medicaid
NY00887554Medicaid
NJ1038109Medicaid
NY87A121Medicare PIN
NJ125719Medicare PIN
NY87A123Medicare PIN
NY87A122Medicare PIN