=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609991892
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STEVEN M GOLDBERG DDS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3601 HEMPSTEAD TPKE SUITE 110
-----------------------------------------------------
City | LEVITTOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-579-7577
-----------------------------------------------------
Fax | 516-731-0240
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 WEST MAIN STREET SUITE 211
-----------------------------------------------------
City | BABYLON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-422-6066
-----------------------------------------------------
Fax | 631-422-6366
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRES
-----------------------------------------------------
Name | STEVEN M GOLDBERG
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 516-579-7577
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 0318241
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------