Provider Demographics
NPI:1861493488
Name:GOLDBERG, DANIEL B (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:B
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:279 3RD AVE
Mailing Address - Street 2:STE 204
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-6210
Mailing Address - Country:US
Mailing Address - Phone:732-741-7845
Mailing Address - Fax:732-571-9212
Practice Address - Street 1:279 3RD AVE
Practice Address - Street 2:STE. 204
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-6211
Practice Address - Country:US
Practice Address - Phone:732-741-7845
Practice Address - Fax:732-571-9212
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA03686500207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ073544Medicare ID - Type Unspecified
NJD96433Medicare UPIN