Provider Demographics
NPI:1952371734
Name:GOLDBERG, ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
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 1:224 TAYLORS MILLS RD
Mailing Address - Street 2:STE. 112
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3281
Mailing Address - Country:US
Mailing Address - Phone:732-577-1066
Mailing Address - Fax:732-577-0049
Practice Address - Street 1:224 TAYLORS MILLS RD
Practice Address - Street 2:STE. 112
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-3281
Practice Address - Country:US
Practice Address - Phone:732-577-1066
Practice Address - Fax:732-577-0049
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA61632207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG32749Medicare UPIN