Provider Demographics
NPI:1023071487
Name:GOLDBERG, ARTHUR I (MD)
Entity type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:I
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 1:1500 ROUTE 112
Mailing Address - Street 2:BLDG 4
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-8055
Mailing Address - Country:US
Mailing Address - Phone:631-751-3000
Mailing Address - Fax:631-509-6559
Practice Address - Street 1:945 5TH AVE OFC 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2667
Practice Address - Country:US
Practice Address - Phone:212-249-0030
Practice Address - Fax:212-744-2413
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY107855174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY133005891OtherTAX ID
NY971001OtherEMPIRE BLUE CROSS SHEILD
NY13-3005891OtherTAX ID
NYNS3165OtherOXFORD HEALTH PLAN ID
NYAG09710010Medicare PIN
NY133005891OtherTAX ID
NY971001Medicare PIN
NY971001Medicare ID - Type UnspecifiedMEDICARE NUMBER