MEDICARE: YANA PAVEL 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
1	2085R0001X	Radiation Oncology Physician	25MA08538700	NJ

General Provider Information

NPI Number	:	1336368646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YANA PAVEL GOLDBERG MD

Provider Business Mailing Address
First Line	:	PO BOX 416457
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02241-6457
Country	:	US
Telephone Number	:	973-656-6280
Fax Number	:	973-290-7495

Provider Business Practice Location Address
First Line	:	100 MADISON AVE
Second Line	:
City	:	MORRISTOWN
State	:	NJ
Zip	:	07962
Country	:	US
Telephone Number	:	973-971-5329
Fax Number	:	973-290-7393

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	05/09/2014

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