=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700928538
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KARYN LISA GOLDBERG D.P.M.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2007
-----------------------------------------------------
Last Update Date | 10/04/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22 OLD SHORT HILLS RD STE 100
-----------------------------------------------------
City | LIVINGSTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07039-5604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-251-2906
-----------------------------------------------------
Fax | 973-369-7035
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22 OLD SHORT HILLS RD STE 110
-----------------------------------------------------
City | LIVINGSTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07039-5605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-251-2906
-----------------------------------------------------
Fax | 973-369-7035
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | MD 02515
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------