Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 25MA04329300 | NJ |
NPI | 1669413324 |
---|---|
Provider Name | David Goldberg |
First Address | Paterson, NJ 07503-2621 |
Second Address | Paterson, NJ 07503-2621 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0035751 | (05) | NJ |
I05433 | (02) |