MEDICARE: DR. ROBERT B GOLDBERG D.O.

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	204C00000X	Sports Medicine (Neuromusculoskeletal Medicine) Physician	135098	NY
2	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	135098	NY
3	208100000X	Physical Medicine & Rehabilitation Physician	135098	NY
4	2081P0004X	Spinal Cord Injury Medicine Physician	135098	NY
5	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	135098	NY
6	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician	135098	NY

General Provider Information

NPI Number	:	1558344309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT B GOLDBERG D.O.

Provider Business Mailing Address
First Line	:	314 W 14TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10014-5002
Country	:	US
Telephone Number	:	212-929-9009
Fax Number	:

Provider Business Practice Location Address
First Line	:	314 W 14TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10014-5002
Country	:	US
Telephone Number	:	212-929-9009
Fax Number	:

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

Provider Enumeration Date	:	11/25/2005
Last Update Date	:	09/23/2010

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