Provider Demographics
NPI:1972574713
Name:GOLDBERG, LON (DO)
Entity type:Individual
Prefix:DR
First Name:LON
Middle Name:
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 STONE GATE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-1452
Mailing Address - Country:US
Mailing Address - Phone:908-704-0100
Mailing Address - Fax:908-704-0900
Practice Address - Street 1:3322 RTE 22
Practice Address - Street 2:BUILDING 1
Practice Address - City:BRANCHBURG
Practice Address - State:NJ
Practice Address - Zip Code:08876-3476
Practice Address - Country:US
Practice Address - Phone:908-704-0100
Practice Address - Fax:908-704-0900
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB04654000207Q00000X
NJMB46540207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE53593Medicare UPIN
NJP00072052Medicare ID - Type UnspecifiedMEDICARE RAILROAD
NJ588707RTJMedicare ID - Type UnspecifiedMEDICARE PROVIDER #