Provider Demographics
NPI:1134239692
Name:ROY J. GOLDBERG, MD, PC
Entity type:Organization
Organization Name:ROY J. GOLDBERG, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-262-4141
Mailing Address - Street 1:PO BOX 483
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:NY
Mailing Address - Zip Code:12563-0483
Mailing Address - Country:US
Mailing Address - Phone:914-262-4141
Mailing Address - Fax:718-405-3501
Practice Address - Street 1:2000 E GUN HILL RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-6016
Practice Address - Country:US
Practice Address - Phone:718-405-3535
Practice Address - Fax:718-405-3501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156644207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00948169Medicaid
NYA63022Medicare UPIN
NY00948169Medicaid