Provider Demographics
NPI:1629222104
Name:JOSEPH GOLDBERG, MD
Entity Type:Organization
Organization Name:JOSEPH GOLDBERG, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-852-9300
Mailing Address - Street 1:91555 OVERSEAS HWY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:TAVERNIER
Mailing Address - State:FL
Mailing Address - Zip Code:33070-2505
Mailing Address - Country:US
Mailing Address - Phone:305-852-9300
Mailing Address - Fax:305-853-1260
Practice Address - Street 1:91555 OVERSEAS HWY
Practice Address - Street 2:SUITE 3
Practice Address - City:TAVERNIER
Practice Address - State:FL
Practice Address - Zip Code:33070-2505
Practice Address - Country:US
Practice Address - Phone:305-852-9300
Practice Address - Fax:305-853-1260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-10
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64068261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374873100Medicaid
FL23965OtherBLUE CROSS BLUE SHIELD
FL23965OtherBLUE CROSS BLUE SHIELD