Provider Demographics
NPI:1033300959
Name:GO AND GO MD PA
Entity Type:Organization
Organization Name:GO AND GO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GO-FARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-736-2900
Mailing Address - Street 1:3452 W BOYNTON BEACH BLVD
Mailing Address - Street 2:SUITE 1-2
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-4633
Mailing Address - Country:US
Mailing Address - Phone:561-736-2900
Mailing Address - Fax:561-736-8444
Practice Address - Street 1:3452 W BOYNTON BEACH BLVD
Practice Address - Street 2:SUITE 1-2
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-4633
Practice Address - Country:US
Practice Address - Phone:561-736-2900
Practice Address - Fax:561-736-8444
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GO AND GO M.D. P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-06
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME36211207R00000X
FLME0041663208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067795700Medicaid
FL067796500Medicaid
FL265620500Medicaid
FL265620500Medicaid
FLD67412Medicare UPIN