Provider Demographics
NPI:1215918438
Name:GOLDBERG, ELIZABETH IVY (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:IVY
Last Name:GOLDBERG
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Gender:F
Credentials:MD
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Mailing Address - Street 1:90 PRINCE ST
Mailing Address - Street 2:2B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-3275
Mailing Address - Country:US
Mailing Address - Phone:516-244-2545
Mailing Address - Fax:212-925-5168
Practice Address - Street 1:345 E 37TH ST
Practice Address - Street 2:307
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3256
Practice Address - Country:US
Practice Address - Phone:212-532-5355
Practice Address - Fax:212-683-8057
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-07
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NY218795207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3K0461Medicare ID - Type Unspecified
NYH95196Medicare UPIN