Provider Demographics
NPI:1386957819
Name:RICHARD N. GOLDBERG, M.D., P.C.
Entity type:Organization
Organization Name:RICHARD N. GOLDBERG, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:N
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-832-8808
Mailing Address - Street 1:211 NEW BRITAIN RD STE 206
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06037-3168
Mailing Address - Country:US
Mailing Address - Phone:860-832-8808
Mailing Address - Fax:860-827-8565
Practice Address - Street 1:211 NEW BRITAIN RD STE 206
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:CT
Practice Address - Zip Code:06037-3168
Practice Address - Country:US
Practice Address - Phone:860-832-8808
Practice Address - Fax:860-827-8565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-26
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty