MEDICARE: DR. SHIRA 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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	25MA08235800	NJ
2	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	25MA08235800	NJ
3	207R00000X	Internal Medicine Physician	25MA08235800	NJ

General Provider Information

NPI Number	:	1710181607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHIRA GOLDBERG MD

Provider Business Mailing Address
First Line	:	PO BOX 8000
Second Line	:	DEPT 596
City	:	BUFFALO
State	:	NY
Zip	:	14267-0002
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 MAIN ST STE 300
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-5439
Country	:	US
Telephone Number	:	855-619-4448
Fax Number	:	732-784-9918

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

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	08/15/2023

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