Organization
LAKE GROVE PEDIATRICS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AMY DAWN GOLDBERG M.D. (OWNER)
63158544400
Entity
Organization
Contact information
Practice address
2233 NESCONSET HWY, SUITE 106, LAKE GROVE, NY 11755-1000
(631) 585-4440
Mailing address
2233 NESCONSET HWY, SUITE 106, LAKE GROVE, NY 11755-1000
(631) 585-4440
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
225178
NY
Other
Enumeration date
05/17/2011
Last updated
05/17/2011
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