Healthcare Provider Details

I. General information

NPI: 1225680580
Provider Name (Legal Business Name): AVIVA GOLDBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E KENNEDY BLVD
LAKEWOOD NJ
08701-1488
US

IV. Provider business mailing address

1201 RIVER AVE UNIT 10
LAKEWOOD NJ
08701-5676
US

V. Phone/Fax

Practice location:
  • Phone: 732-901-0050
  • Fax:
Mailing address:
  • Phone: 732-775-0222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number26NJ0081200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00881200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: