Individual provider Active NPI

Robert Theodore Goldberg, MD

  • Ophthalmology Physician
  • Flushing, NY
National Provider Identifier
1790763399
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
080206 Issued in NY
Practice address
142-10B Roosevelt Ave
Flushing, NY 11354-6046
Phone
(718) 539-2992
Fax
(718) 539-0284
NPI assigned
Jan 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 080206 NY Primary

Addresses

Primary practice location

142-10B Roosevelt Ave
Flushing, NY 11354-6046

Mailing address

142-10B Roosevelt Ave
Flushing, NY 11354-6046
Phone (718) 539-2992

Other identifiers 1

IdentifierTypeStateIssuer
00113997MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130722000330 NY Order and Referring Only - OphthalmologyPractitioner - Ophthalmology 7618118480

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
080206NYMDOphthalmology Physician

NPI Registry JSON

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

{
    "created_epoch": "1136332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1790763399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "142-10B ROOSEVELT AVE",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113546046",
            "telephone_number": "718-539-2992",
            "fax_number": "718-539-0284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "142-10B ROOSEVELT AVE",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113546046",
            "telephone_number": "718-539-2992",
            "fax_number": "718-539-0284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLDBERG",
        "first_name": "ROBERT",
        "middle_name": "THEODORE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-04",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NY",
            "license": "080206",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00113997",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Flushing, NY

Sources for this page

Verify at the official NPI Registry.