Healthcare Provider Details

I. General information

NPI: 1528117926
Provider Name (Legal Business Name): MICHAEL IRA GOLDBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 EASTON AVENUE
NEW BRUNSWICK NJ
08901
US

IV. Provider business mailing address

78 EASTON AVENUE
NEW BRUNSWICK NJ
08901
US

V. Phone/Fax

Practice location:
  • Phone: 732-828-3300
  • Fax: 732-937-5739
Mailing address:
  • Phone: 732-828-3300
  • Fax: 732-937-5739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberMA34713
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: