Healthcare Provider Details

I. General information

NPI: 1952371734
Provider Name (Legal Business Name): ALEXANDER GOLDBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 07/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 TAYLORS MILLS RD STE. 112
MANALAPAN NJ
07726-3281
US

IV. Provider business mailing address

224 TAYLORS MILLS RD STE. 112
MANALAPAN NJ
07726-3281
US

V. Phone/Fax

Practice location:
  • Phone: 732-577-1066
  • Fax: 732-577-0049
Mailing address:
  • Phone: 732-577-1066
  • Fax: 732-577-0049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMA61632
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: