Healthcare Provider Details

I. General information

NPI: 1871171629
Provider Name (Legal Business Name): ALLISON GOLDBERG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1072 TROY SCHENECTADY RD STE 201
LATHAM NY
12110-1025
US

IV. Provider business mailing address

91 BERKSHIRE BLVD
ALBANY NY
12203-2322
US

V. Phone/Fax

Practice location:
  • Phone: 518-722-3877
  • Fax:
Mailing address:
  • Phone: 814-449-4786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number342933-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: