Provider Demographics
NPI:1114093598
Name:GOLDHABER, NEIL G (MD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:G
Last Name:GOLDHABER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 S STATE ROAD 7
Mailing Address - Street 2:SUITE 350
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414
Mailing Address - Country:US
Mailing Address - Phone:561-793-3363
Mailing Address - Fax:561-793-3365
Practice Address - Street 1:1395 S STATE ROAD 7
Practice Address - Street 2:SUITE 350
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414
Practice Address - Country:US
Practice Address - Phone:561-793-3363
Practice Address - Fax:561-793-3365
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0072673174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL41681AMedicare ID - Type Unspecified
FLG55846Medicare UPIN