Provider Demographics
NPI:1205811460
Name:GOLDBERG, MYRON D (MD)
Entity type:Individual
Prefix:DR
First Name:MYRON
Middle Name:D
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5001 GOODRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-2912
Mailing Address - Country:US
Mailing Address - Phone:917-453-1583
Mailing Address - Fax:718-549-1089
Practice Address - Street 1:5001 GOODRIDGE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-2912
Practice Address - Country:US
Practice Address - Phone:917-453-1583
Practice Address - Fax:718-549-1089
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-09
Last Update Date:2025-10-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY112414207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00203503Medicaid
NYB77770Medicare UPIN
NYWLG791Medicare ID - Type Unspecified