Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | N003242 | NY |
Y | 222Z00000X | Podiatrist | N003242 | NY |
NPI | 1073505210 |
---|---|
Provider Name | Dr. Allan Seth Goldberg |
First Address | Plainview, NY 11803-3019 |
Second Address | Far Rockaway, NY 11691 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2005 |
Last Update Date | 21/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00764296 | (05) | NY |
T-45044 | (02) | NY |