Provider Demographics
NPI:1962514034
Name:GOLDBERG, ROY JEFFREY (MD)
Entity type:Individual
Prefix:DR
First Name:ROY
Middle Name:JEFFREY
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:POB 483
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:NY
Mailing Address - Zip Code:12563
Mailing Address - Country:US
Mailing Address - Phone:914-262-4141
Mailing Address - Fax:718-405-3501
Practice Address - Street 1:2000 E GUN HILL RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-6016
Practice Address - Country:US
Practice Address - Phone:718-405-3535
Practice Address - Fax:718-405-3501
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156644207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00948169Medicaid
NYWGC211Medicare ID - Type Unspecified
NYA63022Medicare UPIN