Provider Demographics
NPI:1578823886
Name:HERBERT GOLDWIRE PA
Entity Type:Organization
Organization Name:HERBERT GOLDWIRE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDWIRE
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:954-681-2881
Mailing Address - Street 1:20 NW 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:DANIA
Mailing Address - State:FL
Mailing Address - Zip Code:33004-5107
Mailing Address - Country:US
Mailing Address - Phone:954-681-2881
Mailing Address - Fax:
Practice Address - Street 1:3075 NW 35TH AVE
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33311-1107
Practice Address - Country:US
Practice Address - Phone:954-681-2881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9207809363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty