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General NPI Number Information
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NPI Number | 1003935040
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Entity Type | Organization
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Legal Business Name | GOLDBERG DENTAL OF VALLEY STREAM PC
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 417 WEST MERRICK ROAD
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City | VALLEY STREAM
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State | NY
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Zip | 11580
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Country | US
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Telephone | 516-568-0448
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Fax | 516-561-3024
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Provider Business Mailing Address
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Address Line | 417 WEST MERRICK ROAD
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City | VALLEY STREAM
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State | NY
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Zip | 11580
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Country | US
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Telephone | 516-568-0448
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Fax | 516-561-3024
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Authorized Official
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Title or Position | PRES
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Name | STEVEN M GOLDBERG
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Credential | DDS
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Telephone | 51655680448
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0318241
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License Number State | NY
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