Healthcare Provider Details

I. General information

NPI: 1023938545
Provider Name (Legal Business Name): JULIAN RHYS GOLDBERG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 E 176TH ST STE 113
BRONX NY
10460-4617
US

IV. Provider business mailing address

770 E 176TH ST STE 113 113
BRONX NY
10460-4617
US

V. Phone/Fax

Practice location:
  • Phone: 718-583-5150
  • Fax:
Mailing address:
  • Phone: 718-583-5150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: