Healthcare Provider Details

I. General information

NPI: 1760593164
Provider Name (Legal Business Name): CHELSEA-VILLAGE MEDICAL OFFICE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 W 14TH ST
NEW YORK NY
10014-5002
US

IV. Provider business mailing address

314 W 14TH ST
NEW YORK NY
10014-5002
US

V. Phone/Fax

Practice location:
  • Phone: 212-929-9009
  • Fax: 212-242-6057
Mailing address:
  • Phone: 212-929-9009
  • Fax: 212-242-6057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number135098
License Number StateNY

VIII. Authorized Official

Name: DR. ROBERT B. GOLDBERG
Title or Position: PRESIDENT
Credential: D.O.
Phone: 212-929-9009