Provider Demographics
NPI:1316165541
Name:GOLDBERG, MARY JANE (MS)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:JANE
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07930-0489
Mailing Address - Country:US
Mailing Address - Phone:973-598-8506
Mailing Address - Fax:
Practice Address - Street 1:285 PLEASANT HILL RD
Practice Address - Street 2:
Practice Address - City:FLANDERS
Practice Address - State:NJ
Practice Address - Zip Code:07836-9180
Practice Address - Country:US
Practice Address - Phone:973-598-8506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJYSO2411235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist