Provider Demographics
NPI:1629052618
Name:GOLDBERG, RACHEL (MD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 CREST WOOD CIR
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-9595
Mailing Address - Country:US
Mailing Address - Phone:585-249-9565
Mailing Address - Fax:
Practice Address - Street 1:59 MONROE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-1308
Practice Address - Country:US
Practice Address - Phone:585-385-1710
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214950208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY106167DLOtherPREFERRED CARE
NY000926530001OtherHEALTH NOW PROV NUMBER
NY02150190Medicaid
NY7707321OtherAETNA PROVIDER NUMBER