Provider Demographics
NPI:1992790497
Name:GOLDBERG, ROY ALAN (RPT)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:ALAN
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RADISSON PLAZA
Mailing Address - Street 2:SUITE 901
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801
Mailing Address - Country:US
Mailing Address - Phone:914-632-1100
Mailing Address - Fax:914-632-1182
Practice Address - Street 1:1 RADISSON PLAZA
Practice Address - Street 2:SUITE 901
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801
Practice Address - Country:US
Practice Address - Phone:914-632-1100
Practice Address - Fax:914-632-1182
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0042461174400000X
NY004246-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0469643000OtherAMERIHEALTH #
NY1000001747OtherAFFINITY #
NY128588OtherMPN #
NY006754-A81OtherHEALTHFIRST #
NY133586197OtherTAX IDENTIFICATION #
NYQ6643OtherEMPIRE BCBS
NY0125088OtherAETNA HMO #
NY5526049OtherAETNA PPO #
NY0469643000OtherAMERIHEALTH #
NY128588OtherMPN #