Provider Demographics
NPI:1538836044
Name:GOLDBERG, ANNE JEHLE
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:JEHLE
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 W 57TH ST APT 7I
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3012
Mailing Address - Country:US
Mailing Address - Phone:201-452-0931
Mailing Address - Fax:
Practice Address - Street 1:173 FORT WASHINGTON AVE PH 121270
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3739
Practice Address - Country:US
Practice Address - Phone:212-305-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310404363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health