Provider Demographics
NPI:1912986571
Name:GOLDBERG-BERMAN, JUDITH CAROL (MD, PHD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:CAROL
Last Name:GOLDBERG-BERMAN
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 LAFAYETTE PL
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-5430
Mailing Address - Country:US
Mailing Address - Phone:203-622-9160
Mailing Address - Fax:203-661-3887
Practice Address - Street 1:56 LAFAYETTE PL
Practice Address - Street 2:SUITE A
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-5430
Practice Address - Country:US
Practice Address - Phone:203-622-9160
Practice Address - Fax:203-661-3887
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT033-952174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1912986571OtherNPI
CT30-0602957OtherEIN