Provider Demographics
NPI:1033097449
Name:GOLDBERG, CHAIM
Entity type:Individual
Prefix:
First Name:CHAIM
Middle Name:
Last Name:GOLDBERG
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11707 CURZON RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-3476
Mailing Address - Country:US
Mailing Address - Phone:212-963-9675
Mailing Address - Fax:212-963-9675
Practice Address - Street 1:11707 CURZON RD
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-3476
Practice Address - Country:US
Practice Address - Phone:212-963-9675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-25
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program