Provider Demographics
NPI:1740282649
Name:GOLDBERG, SUSAN C (DPM)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:C
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21679 STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-1812
Mailing Address - Country:US
Mailing Address - Phone:561-482-3338
Mailing Address - Fax:561-482-8024
Practice Address - Street 1:21679 STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-1812
Practice Address - Country:US
Practice Address - Phone:561-482-3338
Practice Address - Fax:561-482-8024
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO0001588213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT55565Medicare UPIN
FL87830ZMedicare ID - Type Unspecified