Healthcare Provider Details

I. General information

NPI: 1639159312
Provider Name (Legal Business Name): DAVID N GOLDBERG D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BALA AVE
BALA CYNWYD PA
19004-3212
US

IV. Provider business mailing address

1 BALA AVE
BALA CYNWYD PA
19004-3212
US

V. Phone/Fax

Practice location:
  • Phone: 610-664-6550
  • Fax:
Mailing address:
  • Phone: 610-664-6550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number25MB04534600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: