Individual
THEODORE GOLDBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12 MEDICAL DR, PORT JEFFERSON STATION, NY 11776-1588
(631) 331-4400
Mailing address
22 WATERVILLE RD, AVON, CT 06001-2066
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
114421
NY
207VG0400X
Gynecology Physician
114421
NY
207VX0000X
Obstetrics Physician
114421
NY
Other
Enumeration date
11/01/2006
Last updated
09/10/2009
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