Healthcare Provider Details

I. General information

NPI: 1033106927
Provider Name (Legal Business Name): HOWARD S GOLDBERG M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 ESTATE DR
FALLSBURG NY
12733
US

IV. Provider business mailing address

10 ESTATE DR
FALLSBURG NY
12733-5038
US

V. Phone/Fax

Practice location:
  • Phone: 845-434-4748
  • Fax: 845-434-4748
Mailing address:
  • Phone: 845-434-4748
  • Fax: 845-434-4748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number275903
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: