Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DS023661L | PA |
NPI | 1033222336 |
---|---|
Provider Name | Dr. Jay Michael Goldberg |
First Address | Phila, PA 19115 |
Second Address | Phila, PA 19115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 04/03/2015 |