MEDICARE: MARC DAVID GOLDBERG P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	024642-1	NY

General Provider Information

NPI Number	:	1093106015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARC DAVID GOLDBERG P.T.

Provider Business Mailing Address
First Line	:	255 W 108TH ST APT 9D
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-2927
Country	:	US
Telephone Number	:	917-699-9707
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 W 108TH ST APT 9D
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-2927
Country	:	US
Telephone Number	:	917-699-9707
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2015
Last Update Date	:	02/12/2015

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