Provider Demographics
NPI:1033481601
Name:MICHAEL S. GOLDMAN DO PA
Entity Type:Organization
Organization Name:MICHAEL S. GOLDMAN DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:561-756-1469
Mailing Address - Street 1:17714 LOMOND CT
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-1032
Mailing Address - Country:US
Mailing Address - Phone:561-756-1469
Mailing Address - Fax:
Practice Address - Street 1:17714 LOMOND CT
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-1032
Practice Address - Country:US
Practice Address - Phone:561-756-1469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-30
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS3831208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2603900-00Medicaid
FL2603900-00Medicaid