Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 201960 | NY |
N | 111NI0900X | Internist | 201960 | NY |
Y | 207RH0003X | Hematology & Oncology | 201960 | NY |
N | 207RX0202X | Medical Oncology | 201960 | NY |
NPI | 1134172349 |
---|---|
Provider Name | Jonathan S Goldberg |
First Address | Mount Kisco, NY 10549-3446 |
Second Address | Brewster, NY 10509-2337 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 17/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02138498 | (05) | NY |
0667910001 | DME (01) | NY |
P00232099 | MEDICARE RAILROAD (01) | NY |