Provider Demographics
NPI:1174980577
Name:EDWARD GOLDBERG LLC
Entity type:Organization
Organization Name:EDWARD GOLDBERG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:ARON
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-348-2234
Mailing Address - Street 1:99 N BRICE RD
Mailing Address - Street 2:STE 300
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-6519
Mailing Address - Country:US
Mailing Address - Phone:614-726-0596
Mailing Address - Fax:614-547-6811
Practice Address - Street 1:99 N BRICE RD
Practice Address - Street 2:STE 300
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-6519
Practice Address - Country:US
Practice Address - Phone:614-726-0596
Practice Address - Fax:614-547-6811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-15
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain MedicineGroup - Multi-Specialty
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0156457Medicaid
OHH377520Medicare PIN