Individual ProviderRegina GoldbergPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address500 Seaview Ave, Suite 240, Staten Island, NY 10305-3421(718) 667-1777PECOS EnrollmentBased on the most recent information from CMS, provider Regina Goldberg does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 6 days ago.Profile DetailsProvider ID1003354622Provider TypeIndividualFull NameGoldberg, ReginaCredentialPAGenderFemaleSole ProprietorNoEnumeration Date2/2/2017Last Updated2/2/2017Contact InformationPractice LocationPractice Address500 Seaview Ave, Suite 240, Staten Island, NY 10305-3421Phone(718) 667-1777Fax(718) 667-4380Mailing LocationMailing Address500 Seaview Ave, Suite 240, Staten Island, NY 10305Phone(718) 667-1777Fax(718) 667-4380Provider TaxonomiesCodeDescriptionLicenseCode363A00000XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicense004935-1New York