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Individual
ROY ALAN GOLDBERG
Active
Individual
ROY ALAN GOLDBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPT
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
0042461
NY
225100000X
Physical Therapist
Primary
004246-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006754-A81
HEALTHFIRST #
NY
01
—
0125088
AETNA HMO #
NY
01
—
0469643000
AMERIHEALTH #
NY
01
—
1000001747
AFFINITY #
NY
01
—
128588
MPN #
NY
01
—
133586197
TAX IDENTIFICATION #
NY
01
—
5526049
AETNA PPO #
NY
01
—
Q6643
EMPIRE BCBS
NY
Enumeration date
09/12/2005
Last updated
05/03/2011
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