MEDICARE: MS. JOAN B GOLDBERG PHD

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	103T00000X	Psychologist	005322	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0029720	OTHER	NY	VALUE OPTIONS INSURANCE
2	P1252361	OTHER	NY	OXFORD INSURANCE
3	00532268	OTHER	NY	HIP INSURANCE
4	0029720	OTHER		GHI INSURANCE

General Provider Information

NPI Number	:	1841383015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JOAN B GOLDBERG PHD

Provider Business Mailing Address
First Line	:	505 ELMWOOD AVENUE
Second Line	:	#5K
City	:	BROOKLYN
State	:	NY
Zip	:	11230
Country	:	US
Telephone Number	:	718-258-5439
Fax Number	:	718-258-5439

Provider Business Practice Location Address
First Line	:	690 BROADWAY
Second Line	:	SUITE 1 1ST FLOOR
City	:	MASSAPEQUA
State	:	NY
Zip	:	11758
Country	:	US
Telephone Number	:	718-258-5439
Fax Number	:	718-258-5439

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/08/2007

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