MEDICARE: DR. ARTHUR I GOLDBERG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	107855	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	133005891	OTHER	NY	TAX ID
2	971001	OTHER	NY	EMPIRE BLUE CROSS SHEILD
3	13-3005891	OTHER	NY	TAX ID
4	NS3165	OTHER	NY	OXFORD HEALTH PLAN ID

General Provider Information

NPI Number	:	1023071487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARTHUR I GOLDBERG M.D.

Provider Business Mailing Address
First Line	:	1500 ROUTE 112
Second Line	:	BLDG 4
City	:	PORT JEFFERSON STATION
State	:	NY
Zip	:	11776-8055
Country	:	US
Telephone Number	:	631-751-3000
Fax Number	:	631-509-6559

Provider Business Practice Location Address
First Line	:	945 5TH AVE OFC 6
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10021-2667
Country	:	US
Telephone Number	:	212-249-0030
Fax Number	:	212-744-2413

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	12/16/2019

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