Provider Demographics
NPI:1538421805
Name:GOLDBERG, LINDA ROBYN (MSED)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ROBYN
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 BROMPTON RD
Mailing Address - Street 2:3J
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3453
Mailing Address - Country:US
Mailing Address - Phone:516-773-4945
Mailing Address - Fax:
Practice Address - Street 1:50 BROMPTON RD
Practice Address - Street 2:3J
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-3453
Practice Address - Country:US
Practice Address - Phone:516-773-4945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist