Active NPI
Michael R Goldberg, PH.D.
- Clinical Psychologist
- Garden City, NY
National Provider Identifier
1003215385
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 020798-1
- Practice address
- 243 Nassau Blvd
Garden City, NY 11530-5532 - Phone
- (347) 694-5655
- NPI assigned
- Aug 22, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 020798-1 | NY | Primary |
Addresses
Primary practice location
243 Nassau Blvd
Garden City, NY 11530-5532
Mailing address
243 Nassau Blvd
Garden City, NY 11530-5532
Phone (347) 694-5655
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 020798-1 | NY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1408665600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1551225600000",
"number": "1003215385",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "243 NASSAU BLVD",
"city": "GARDEN CITY",
"state": "NY",
"postal_code": "115305532",
"telephone_number": "347-694-5655"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "243 NASSAU BLVD",
"city": "GARDEN CITY",
"state": "NY",
"postal_code": "115305532",
"telephone_number": "347-694-5655"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOLDBERG",
"first_name": "MICHAEL",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-08-22",
"last_updated": "2019-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "020798-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Garden City, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.