MEDICARE: JORY J 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	207R00000X	Internal Medicine Physician	MA36882	NJ
2	207RP1001X	Pulmonary Disease Physician	MA36882	NJ
3	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	25MA03688200	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407841638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORY J GOLDBERG M.D.

Provider Business Mailing Address
First Line	:	18 CENTRE DR
Second Line	:	SUITE 103
City	:	MONROE TWP
State	:	NJ
Zip	:	08831-1501
Country	:	US
Telephone Number	:	609-655-1700
Fax Number	:	609-655-4455

Provider Business Practice Location Address
First Line	:	18 CENTRE DR
Second Line	:	SUITE 103
City	:	MONROE TWP
State	:	NJ
Zip	:	08831-1501
Country	:	US
Telephone Number	:	609-655-1700
Fax Number	:	609-655-4455

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

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	12/30/2013

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