Individual
MR. JODY FERN GOLDBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
9037 PARSONS BLVD, JAMAICA, NY 11432-6032
(718) 334-6400
(718) 334-6430
Mailing address
7901 BROADWAY, MANAGED CARE, D1-01, ELMHURST, NY 11373-1329
(718) 334-1921
(718) 334-3432
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
161405
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00246075
—
NY
Enumeration date
09/28/2006
Last updated
05/18/2015
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