Provider Demographics
NPI:1740383280
Name:GOLDBERG, STEVEN JOEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JOEL
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 INDIAN HILL RD
Mailing Address - Street 2:
Mailing Address - City:MT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549
Mailing Address - Country:US
Mailing Address - Phone:914-241-2059
Mailing Address - Fax:
Practice Address - Street 1:ONE PONDFIELD ROAD WEST
Practice Address - Street 2:SUITE 3
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-2666
Practice Address - Country:US
Practice Address - Phone:914-779-0111
Practice Address - Fax:914-771-8417
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0293381223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T419910Medicare UPIN
D6A781Medicare ID - Type Unspecified