MEDICARE: DR. ERIC 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
1	207R00000X	Internal Medicine Physician	46212	AZ
2	207R00000X	Internal Medicine Physician	204231	NY

General Provider Information

NPI Number	:	1659379014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC R GOLDBERG MD

Provider Business Mailing Address
First Line	:	693 5TH AVE FL 15
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-3160
Country	:	US
Telephone Number	:	212-540-4210
Fax Number	:

Provider Business Practice Location Address
First Line	:	693 5TH AVE FL 15
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-3160
Country	:	US
Telephone Number	:	212-540-4210
Fax Number	:	212-540-4213

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

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	06/08/2023

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