Provider Demographics
NPI:1215191994
Name:GOLDBERG, WILLIAM PAUL (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:PAUL
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:579 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840
Mailing Address - Country:US
Mailing Address - Phone:732-902-2332
Mailing Address - Fax:732-906-9433
Practice Address - Street 1:579 MAIN ST
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840
Practice Address - Country:US
Practice Address - Phone:732-902-2332
Practice Address - Fax:732-906-9433
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA40874207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC58488Medicare UPIN