Active NPI
Jeffrey Ward Goldberg, OPTICIAN
- Optician
- Valley Stream, NY
National Provider Identifier
1669542767
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 004302
- Practice address
- 1033 Green Acres Mall
Valley Stream, NY 11581-1531 - Phone
- (516) 825-8990
- Fax
- (516) 872-2702
- NPI assigned
- Nov 8, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Optician | 156FX1800X | 004302 | NY | Primary |
Addresses
Primary practice location
1033 Green Acres Mall
Valley Stream, NY 11581-1531
Mailing address
836 Van Buren St
Baldwin, NY 11510-4652
Phone (516) 825-8990
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 004302 | NY | MD | Acupuncturist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| South Shore Opticians Inc | Optician | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1669542767",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "836 VAN BUREN ST",
"city": "BALDWIN",
"state": "NY",
"postal_code": "115104652",
"telephone_number": "516-825-8990"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1033 GREEN ACRES MALL",
"city": "VALLEY STREAM",
"state": "NY",
"postal_code": "115811531",
"telephone_number": "516-825-8990",
"fax_number": "516-872-2702"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOLDBERG",
"first_name": "JEFFREY",
"middle_name": "WARD",
"credential": "OPTICIAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "NY",
"license": "004302",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Valley Stream, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.