Provider Demographics
NPI:1821002452
Name:GOLDBERG, IRWIN L (DO)
Entity Type:Individual
Prefix:DR
First Name:IRWIN
Middle Name:L
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 MULE ROAD
Mailing Address - Street 2:SUITE #9
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08757-6460
Mailing Address - Country:US
Mailing Address - Phone:732-914-8118
Mailing Address - Fax:732-914-8887
Practice Address - Street 1:600 MULE RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08757-6460
Practice Address - Country:US
Practice Address - Phone:732-914-8118
Practice Address - Fax:732-914-8887
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB031718207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD19622Medicare UPIN