Individual
DR. ELLEN GOLDBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
1771 MADISON AVE, LAKEWOOD, NJ 08701
(732) 364-2144
(732) 534-8064
Mailing address
1771 MADISON AVE, LAKEWOOD, NJ 08701
(732) 364-2144
(732) 534-8064
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
22DI01509500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0220396
—
NJ
Enumeration date
11/20/2009
Last updated
05/23/2013
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