| Doctor Name: | JAY STEPHEN GOLDBERG |
| NPI Number: | 1477654291 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 0101021527 |
| Business Practice Address: | 430 Claremont Ct Suite 213 Colonial Heights, VA - 238341770 |
| Business Phone Number: | 8045202626 |
| Business Fax Number: | 8045200626 |
| Mailing Address: | 430 Claremont Ct, Suite 213 COLONIAL HEIGHTS |
| State: | VA |
| Postal Code: | 238341770 |
| Phone Number: | 8045202626 |
| Fax Number: | 8045200626 |
| NPI Enumeration Date: | 09/26/2006 |
| NPI Last Update Date: | 01/29/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 0101021527 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |