Provider Demographics
NPI:1912084062
Name:GOLDBERG, NIECA (MD)
Entity Type:Individual
Prefix:
First Name:NIECA
Middle Name:
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 E 87TH ST
Mailing Address - Street 2:SUITE 503
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-2226
Mailing Address - Country:US
Mailing Address - Phone:212-289-2045
Mailing Address - Fax:
Practice Address - Street 1:530 1ST AVE # HCC7H
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6402
Practice Address - Country:US
Practice Address - Phone:212-263-0474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY163655207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYO1241336Medicaid
0546091OtherCIGNA HEALTH PLAN
96526066OtherONE HEALTH PLAN
P2845392OtherOXFORD HEALTH PLAN
810603531OtherUNITED HEALTH CARE
NY488Q62OtherEMPIRE BC/BS
P2845392OtherOXFORD HEALTH PLAN
NYO1241336Medicaid