Provider Demographics
NPI:1992731780
Name:GOLDBERG, DOUGLAS ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ALAN
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 EXPRESSWAY PLZ
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2047
Mailing Address - Country:US
Mailing Address - Phone:516-626-0700
Mailing Address - Fax:516-626-1190
Practice Address - Street 1:1 EXPRESSWAY PLZ
Practice Address - Street 2:SUITE 220
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-2047
Practice Address - Country:US
Practice Address - Phone:516-626-0700
Practice Address - Fax:516-626-1190
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2021-02-25
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Provider Licenses
StateLicense IDTaxonomies
NY158604207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400000511Medicare PIN