Provider Demographics
NPI:1891982583
Name:SHELDON GOLDBERG MD PC
Entity Type:Organization
Organization Name:SHELDON GOLDBERG MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELDON
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-424-6565
Mailing Address - Street 1:3232 S VANCE ST
Mailing Address - Street 2:# 220
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-5029
Mailing Address - Country:US
Mailing Address - Phone:719-262-0511
Mailing Address - Fax:719-262-0677
Practice Address - Street 1:4485 WADSWORTH BLVD
Practice Address - Street 2:# 301
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-3318
Practice Address - Country:US
Practice Address - Phone:303-424-6565
Practice Address - Fax:719-262-0677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC553098Medicare PIN