Healthcare Provider Details

I. General information

NPI: 1487688537
Provider Name (Legal Business Name): STEVEN GOLDBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 11/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 NEW BRUNSWICK AVE
FORDS NJ
08863-2110
US

IV. Provider business mailing address

3 HOSPITAL PLZ STE 314
OLD BRIDGE NJ
08857-3096
US

V. Phone/Fax

Practice location:
  • Phone: 732-738-4260
  • Fax:
Mailing address:
  • Phone: 732-324-3250
  • Fax: 732-324-3255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA04981500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: