MEDICARE: DR. JOEL GOLDBERG MD

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	207RC0000X	Cardiovascular Disease Physician	138481	NY

General Provider Information

NPI Number	:	1376589655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOEL GOLDBERG MD

Provider Business Mailing Address
First Line	:	310 E SHORE RD
Second Line	:	SUITE 104
City	:	GREAT NECK
State	:	NY
Zip	:	11023-2432
Country	:	US
Telephone Number	:	516-829-9550
Fax Number	:	516-829-9718

Provider Business Practice Location Address
First Line	:	310 E SHORE RD
Second Line	:	SUITE 104
City	:	GREAT NECK
State	:	NY
Zip	:	11023-2432
Country	:	US
Telephone Number	:	516-829-9550
Fax Number	:	516-829-9718

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

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	02/01/2012

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