Individual
MR. MARK GOLDBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
C.P.O
Contact information
Practice address
9 TECHNOLOGY DR, EAST SETAUKET, NY 11733-4000
(631) 689-6606
(631) 941-3525
Mailing address
9 TECHNOLOGY DR, EAST SETAUKET, NY 11733-4000
(631) 689-6606
(631) 941-3525
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
—
—
224P00000X
Prosthetist
—
—
225000000X
Orthotic Fitter
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01077018
—
NY
Enumeration date
10/10/2006
Last updated
09/11/2025
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