Individual provider Active NPI

Ian Simon Goldberg, MD

  • Psychiatry Physician
  • New York, NY
National Provider Identifier
1881605863
Registry record updated Apr 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
NY171577 Issued in NY
Practice address
109 W 27TH St RM 5S
New York, NY 10001-6208
Phone
(917) 634-5311
Fax
(888) 815-3583
NPI assigned
Aug 11, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 30, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X NY171577 NY Primary

Addresses

Primary practice location

109 W 27TH St RM 5S
New York, NY 10001-6208

Mailing address

109 W 27TH St RM 5S
New York, NY 10001-6208
Phone (917) 634-5311

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
I20031209000149 NY Practitioner - Psychiatry 4385540673 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
MCCD Psychiatry Services PLLCGroup PAC ID 4082049036, 206 clinicians

Practice addresses (Care Compare)

109 W 27TH St
5S
New York, NY 10001-6208
Phone (833) 351-8255

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
NY171577NYMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
MCCD Psychiatry Services PLLC Psychiatry CurrentSince May 1, 2022 Accepting new patients
NYU Langone Hospitals CurrentSince Dec 27, 2016 Accepting new patients
NYU Langone Hospitals Current Accepting new patients
NYU Langone Hospitals CurrentSince Dec 27, 2016 Accepting new patients

Locations

514 49th St
Rm 316
Brooklyn, NY 11220

109 W 27th St
#55
New York, NY 10001

301 E 17th St
New York, NY 10003
Phone (212) 460-0125

109 W 27th St
Rm 5S
New York, NY 10001
Phone (332) 230-4572

14 Wall St
Fl 9
Wall Street, NY 10005
Phone (646) 501-3224

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745971200000",
    "number": "1881605863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 W 27TH ST RM 5S",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100016208",
            "telephone_number": "917-634-5311",
            "fax_number": "888-815-3583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 W 27TH ST RM 5S",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100016208",
            "telephone_number": "917-634-5311",
            "fax_number": "888-815-3583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLDBERG",
        "first_name": "IAN",
        "middle_name": "SIMON",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-11",
        "last_updated": "2025-04-30",
        "certification_date": "2025-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "NY171577",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.