Lake Grove Pediatrics, PC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

225178 Issued in NY

Legal business name

LAKE GROVE PEDIATRICS, PC

Practice address

2233 Nesconset Hwy
Suite 106
Lake Grove, NY 11755-1000

Phone

(631) 585-4440

NPI assigned

May 17, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Amy Dawn Goldberg, M.D.

Title

Owner

Phone

63158544400

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1305590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305590400000",
    "number": "1447543913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2233 NESCONSET HWY",
            "address_2": "SUITE 106",
            "city": "LAKE GROVE",
            "state": "NY",
            "postal_code": "117551000",
            "telephone_number": "631-585-4440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2233 NESCONSET HWY",
            "address_2": "SUITE 106",
            "city": "LAKE GROVE",
            "state": "NY",
            "postal_code": "117551000",
            "telephone_number": "631-585-4440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE GROVE PEDIATRICS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-17",
        "last_updated": "2011-05-17",
        "status": "A",
        "authorized_official_last_name": "GOLDBERG",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "63158544400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "225178",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatrics Physician in Lake Grove, NY
• Providers in Lake Grove, NY by specialty
• Pediatrics Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.