Provider Demographics
NPI:1891824132
Name:GOLDBERG, PETER (LIC AC)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MILLER VIEW RD
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-9085
Mailing Address - Country:US
Mailing Address - Phone:413-528-5055
Mailing Address - Fax:
Practice Address - Street 1:11 MILLER VIEW RD
Practice Address - Street 2:
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-9085
Practice Address - Country:US
Practice Address - Phone:413-528-5055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA358171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist