Healthcare Provider Details

I. General information

NPI: 1780628362
Provider Name (Legal Business Name): ROBERT GOLDBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 ESQUIRE RD SUITE 6
NEW CITY NY
10956-3336
US

IV. Provider business mailing address

10 ESQUIRE RD SUITE 6
NEW CITY NY
10956-3336
US

V. Phone/Fax

Practice location:
  • Phone: 845-634-2727
  • Fax: 845-634-2882
Mailing address:
  • Phone: 845-634-2727
  • Fax: 845-634-2882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number143731
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: