Provider Demographics
NPI:1669629218
Name:GOLDBERG, JUDAH LEV (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDAH
Middle Name:LEV
Last Name:GOLDBERG
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 1:15 HA-ZAYIT STREET
Mailing Address - Street 2:
Mailing Address - City:ALON SHEVUT
Mailing Address - State:GUSH ETZION
Mailing Address - Zip Code:90433
Mailing Address - Country:IL
Mailing Address - Phone:516-321-1286
Mailing Address - Fax:
Practice Address - Street 1:703 N FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1006
Practice Address - Country:US
Practice Address - Phone:954-844-7120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME110696207P00000X
NY250749207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03238617Medicaid
NY03238617Medicaid