Provider Demographics
NPI:1700920998
Name:RICHARD GOLDBERG AND JOHN PELLEGRINI P.C.
Entity Type:Organization
Organization Name:RICHARD GOLDBERG AND JOHN PELLEGRINI P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PRACTIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:MARLOWE
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-748-5482
Mailing Address - Street 1:437 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-5126
Mailing Address - Country:US
Mailing Address - Phone:718-448-6381
Mailing Address - Fax:
Practice Address - Street 1:8518 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-4608
Practice Address - Country:US
Practice Address - Phone:718-748-5482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152639208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
77D37Medicare ID - Type Unspecified
B19304Medicare UPIN