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NPI Code Detail

MEDICARE: DR. GRIGORY R GOLDBERG MD

MEDICARE: DR. GRIGORY R GOLDBERG MD
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
1207XS0117XOrthopaedic Surgery of the Spine Physician35-089481OH
2207XS0117XOrthopaedic Surgery of the Spine Physician39810KY
3207XS0117XOrthopaedic Surgery of the Spine Physician25MA08514200NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000526432OTHEROHANTHEM
2000000485763OTHERKYANTHEM
3165869OTHEROHNATIONWIDE

General Provider Information

NPI Number : 1033142112
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GRIGORY R GOLDBERG MD
Provider Business Mailing Address
First Line : 1200 EAGLE AVE
Second Line :
City : OCEAN
State : NJ
Zip : 07712-7631
Country : US
Telephone Number : 732-660-6200
Fax Number :
Provider Business Practice Location Address
First Line : 1200 EAGLE AVE
Second Line :
City : OCEAN
State : NJ
Zip : 07712-7631
Country : US
Telephone Number : 732-660-6200
Fax Number : 732-660-6201
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2006
Last Update Date : 07/30/2020

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