Provider Demographics
NPI:1780628362
Name:GOLDBERG, ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
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 1:10 ESQUIRE RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-3336
Mailing Address - Country:US
Mailing Address - Phone:845-634-2727
Mailing Address - Fax:845-634-2882
Practice Address - Street 1:10 ESQUIRE RD
Practice Address - Street 2:SUITE 6
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-3336
Practice Address - Country:US
Practice Address - Phone:845-634-2727
Practice Address - Fax:845-634-2882
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143731207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00995455Medicaid
NYP1964971OtherOXFORD
NY0M081POtherHIP
NY1Z7862OtherBCBS
NY4202054OtherAETNA
NY4362OtherGHI
NY0M081POtherHIP
NY830005109Medicare PIN
NYP1964971OtherOXFORD