Provider Demographics
NPI:1659379014
Name:GOLDBERG, ERIC R (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:R
Last Name:GOLDBERG
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 1:693 5TH AVE FL 15
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-3160
Mailing Address - Country:US
Mailing Address - Phone:212-540-4210
Mailing Address - Fax:
Practice Address - Street 1:693 5TH AVE FL 15
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-3160
Practice Address - Country:US
Practice Address - Phone:212-540-4210
Practice Address - Fax:212-540-4213
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ46212207R00000X
NY204231207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02009603Medicaid
NY54N151Medicare ID - Type Unspecified
NY02009603Medicaid