Healthcare Provider Details

I. General information

NPI: 1740383280
Provider Name (Legal Business Name): STEVEN JOEL GOLDBERG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE PONDFIELD ROAD WEST SUITE 3
BRONXVILLE NY
10708-2666
US

IV. Provider business mailing address

36 INDIAN HILL RD
MT KISCO NY
10549
US

V. Phone/Fax

Practice location:
  • Phone: 914-779-0111
  • Fax: 914-771-8417
Mailing address:
  • Phone: 914-241-2059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number029338
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: