Provider Demographics
NPI:1700928538
Name:GOLDBERG, KARYN LISA (DPM)
Entity Type:Individual
Prefix:DR
First Name:KARYN
Middle Name:LISA
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 OLD SHORT HILLS RD STE 110
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-5605
Mailing Address - Country:US
Mailing Address - Phone:973-251-2906
Mailing Address - Fax:973-369-7035
Practice Address - Street 1:22 OLD SHORT HILLS RD STE 100
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5604
Practice Address - Country:US
Practice Address - Phone:973-251-2906
Practice Address - Fax:973-369-7035
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD 02515213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7972105Medicaid
NJ027325Medicare ID - Type Unspecified
NJ217157NMPMedicare PIN
NJ7972105Medicaid