Provider Demographics
NPI:1699823781
Name:GOLDBERG, HARVEY (MD)
Entity type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:
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 1:905 MANOR LN
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-7526
Mailing Address - Country:US
Mailing Address - Phone:631-969-1248
Mailing Address - Fax:631-968-4383
Practice Address - Street 1:260 W MAIN ST
Practice Address - Street 2:SUITE 12
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8322
Practice Address - Country:US
Practice Address - Phone:631-969-1248
Practice Address - Fax:631-968-4383
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1605792081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine