Provider Demographics
NPI:1083725535
Name:SAMUEL GOLDBERG MD PC
Entity Type:Organization
Organization Name:SAMUEL GOLDBERG MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-839-1250
Mailing Address - Street 1:2600 E SOUTHERN AVE
Mailing Address - Street 2:SUITE J1
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7610
Mailing Address - Country:US
Mailing Address - Phone:480-839-1250
Mailing Address - Fax:
Practice Address - Street 1:2600 E SOUTHERN AVE
Practice Address - Street 2:SUITE J1
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7610
Practice Address - Country:US
Practice Address - Phone:480-839-1250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ324322877Medicare PIN