Provider Demographics
NPI:1922037290
Name:PAIN MANAGEMENT PHYSICIANS OF SOUTH FLORIDA, P.L.
Entity Type:Organization
Organization Name:PAIN MANAGEMENT PHYSICIANS OF SOUTH FLORIDA, P.L.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-605-3724
Mailing Address - Street 1:6295 NW 96TH TER
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-1815
Mailing Address - Country:US
Mailing Address - Phone:954-605-3724
Mailing Address - Fax:954-255-9147
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 66192207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME 66192OtherPROVIDER LICENSE NUMBER