Michael Jay Goldberg, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

A025404 Issued in CA

Practice address

5620 Wilbur Ave
Suite 212
Tarzana, CA 91856

Phone

(818) 343-1010

Fax

(818) 343-6585

NPI assigned

Dec 27, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Nov 1, 2018 through Nov 1, 2026

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530057600000",
    "number": "1437214517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5620 WILBUR AVE #212",
            "city": "TARZANA",
            "state": "CA",
            "postal_code": "91356",
            "telephone_number": "818-343-1010",
            "fax_number": "818-343-6585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5620 WILBUR AVE",
            "address_2": "SUITE 212",
            "city": "TARZANA",
            "state": "CA",
            "postal_code": "91856",
            "telephone_number": "818-343-1010",
            "fax_number": "818-343-6585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLDBERG",
        "first_name": "MICHAEL",
        "middle_name": "JAY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-27",
        "last_updated": "2018-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "A025404",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Goho Inc.
• Lianna Raquel Gold, MS, OTR/L
• Tamara Gold, L.C.S.W
• Adva Goldberg
• Bennett Ira Goldberg, MA, MFTI
• Phyllis Goldberg, PH.D.
• Golden Age Adult Day Health Care Center, Inc.
• Golden Age Skilled Services
• Golden Gate Home Care
• Golden State Family Care LLC

• Specialist in Tarzana, CA
• Providers in Tarzana, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.