Provider Demographics
NPI:1164472239
Name:GOLDBERG, ANDREW JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JAY
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8880 ROYAL PALM BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065
Mailing Address - Country:US
Mailing Address - Phone:954-975-8233
Mailing Address - Fax:954-974-2335
Practice Address - Street 1:8880 ROYAL PALM BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5727
Practice Address - Country:US
Practice Address - Phone:954-975-8233
Practice Address - Fax:954-974-2335
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME66192208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F76054Medicare UPIN