Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | MA34713 | NJ |
NPI | 1528117926 |
---|---|
Provider Name | Dr. Michael Ira Goldberg |
First Address | New Brunswick, NJ 08901 |
Second Address | New Brunswick, NJ 08901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 29/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3092305 | (05) | NJ |
D06080 | (02) |